Department of Medicine, Federal University of Sergipe, Aracaju, Brazil.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1676-83. doi: 10.2215/CJN.09041010. Epub 2011 Jun 23.
Although low socioeconomic status has been considered a contraindication to peritoneal dialysis (PD), no published data clearly link it to poor outcomes. The goal of this study was assessing the effect of income on survival in the Brazilian Peritoneal Dialysis Multicenter STUDY.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Incident PD patients enrolled in this prospective cohort from December 2004 to October 2007 were divided according to monthly family income. The median age was 59 years, 54% were women, 60% Caucasians, 41% diabetics, and 24% had cardiovascular disease. Most of them were in continuous ambulatory PD, had not received predialysis care, had <4 school years, and had a family income of <5 minimum wage (80%). Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model adjusting the results for age, gender, educational status, predialysis care, first therapy, PD modality, calendar year, and comorbidities.
There were no differences in technique (log rank test χ² = 4.36) and patient (log rank test χ² = 2.92) survival between the groups. In the multivariate analysis, low family income remained not associated either to worse technique survival (hazard ratio [HR] = 1.29; 95% confidence interval [CI] = 0.91 to 1.84) or to patient survival (HR = 1.40; 95% CI = 0.99 to 1.99).
According to these results, economic status is not independently associated with outcomes in this large cohort and should not be considered a barrier for PD indication.
尽管社会经济地位较低被认为是腹膜透析（PD）的禁忌症，但尚无明确数据表明其与不良结局相关。本研究旨在评估收入对巴西腹膜透析多中心研究中患者生存的影响。
设计、地点、参与者和测量方法：本前瞻性队列研究于 2004 年 12 月至 2007 年 10 月期间纳入新开始 PD 的患者，根据患者家庭月收入进行分组。患者的中位年龄为 59 岁，54%为女性，60%为白种人，41%患有糖尿病，24%患有心血管疾病。大多数患者接受持续不卧床 PD 治疗，未接受透析前护理，受教育程度<4 年，家庭收入<5 最低工资（80%）。采用 Kaplan-Meier 方法进行生存分析，并使用 Cox 比例风险模型调整年龄、性别、受教育程度、透析前护理、初始治疗、PD 方式、日历年份和合并症对结果的影响。
各组间技术（对数秩检验 χ²=4.36）和患者（对数秩检验 χ²=2.92）生存率无差异。多变量分析显示，家庭收入较低与技术生存率（风险比 [HR] = 1.29；95%置信区间 [CI] = 0.91 至 1.84）或患者生存率（HR = 1.40；95%CI = 0.99 至 1.99）均无相关性。
根据这些结果，在这个大型队列中，经济状况与结局之间无独立相关性，不应将其视为 PD 适应证的障碍。
