Franco Ricardo Portiolli, Chula Domingos Candiota, de Moraes Thyago Proença, Campos Rodrigo Peixoto
Interventional Nephrology Center, Fundação Pró-Renal, Curitiba, Brazil.
Department of Nephrology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Front Nephrol. 2022 Dec 7;2:985449. doi: 10.3389/fneph.2022.985449. eCollection 2022.
In Brazil, most hemodialysis (HD) patients are treated by the country's public health system. However, accessibility to healthcare is different for public and private patients. This study aimed to identify the profile of vascular access in a Brazilian HD sample. Additionally, it aimed to examine the influence of public and private health insurance, accessibility to endovascular treatments, and timely arteriovenous access creation on the prevalence of tunneled catheters (TCs), non-tunneled catheters (NTCs), and arteriovenous (AV) access. We conducted a cross-sectional electronic survey across 834 centers. Centers were inquired about the number of patients with public and private health insurance, the profiles of vascular access, time for AV access creation, accessibility to TC insertion and endovascular treatments, and the availability of peritoneal dialysis and kidney transplantation. Logistic regression and multilevel logistic regression were performed to evaluate possible interactions between the independent variables. A total of 7,973 patients across 47 HD centers were included in the survey. Public health patients accounted for 77% of the study sample. The overall vascular access profiles of the public and private insurance groups were significantly different ( < 0.001). For patients with public health insurance, the prevalence of any catheter was 25%, while that for private patients was 31.8% ( < 0.001). The prevalence of TCs was more common in private patients (15.3% vs. 23.1%, < 0.001). AV accesses were more common in public health patients (75% vs. 68.2%, < 0.001), as were fistulas (72.4% vs. 63.1%, < 0.001). AV grafts were more prevalent among patients with private insurance (2.6 vs. 5.1%, < 0.001). The availability of endovascular treatments increased the chance of having a TC by 2.3-fold (OR = 2.33, 95% CI = 1.30-4.18); however, it did not reduce the chance of having any catheter. A high chance of having a catheter was found when the time to AV access creation exceeded 60 days. The differences between public and private patients may be explained by underpayments and the decreased accessibility to care infrastructure in the public system, especially for endovascular treatments. In this sample, public health patients had a decreased risk of having a TC over an NTC. Differences in care accessibility and insurance type might influence the type of vascular access.
在巴西，大多数血液透析（HD）患者由该国的公共卫生系统进行治疗。然而，公立和私立患者获得医疗服务的机会有所不同。本研究旨在确定巴西血液透析样本中血管通路的特征。此外，研究旨在探讨公共和私人医疗保险、血管内治疗的可及性以及及时建立动静脉通路对隧道式导管（TCs）、非隧道式导管（NTCs）和动静脉（AV）通路患病率的影响。我们对834个中心进行了横断面电子调查。询问各中心公立和私立医疗保险患者的数量、血管通路特征、建立AV通路的时间、TC插入和血管内治疗的可及性，以及腹膜透析和肾移植的可获得性。进行逻辑回归和多水平逻辑回归以评估自变量之间可能的相互作用。该调查共纳入了47个血液透析中心的7973名患者。公立医疗患者占研究样本的77%。公立和私立保险组的总体血管通路特征存在显著差异（<0.001）。对于有公共医疗保险的患者，任何导管的患病率为25%，而私立患者为31.8%（<0.001）。TCs在私立患者中更为常见（15.3%对23.1%，<0.001）。AV通路在公立医疗患者中更为常见（75%对68.2%，<0.001），瘘管也是如此（72.4%对63.1%，<0.001）。AV移植物在有私人保险的患者中更为普遍（2.6%对5.1%，<0.001）。血管内治疗的可及性使拥有TC的几率增加了2.3倍（OR = 2.33，95%CI = 1.30 - 4.18）；然而，它并没有降低拥有任何导管的几率。当建立AV通路的时间超过60天时，拥有导管的几率较高。公立和私立患者之间的差异可能是由于公立系统中支付不足以及获得医疗基础设施的机会减少，特别是对于血管内治疗。在这个样本中，公立医疗患者使用TC而非NTC的风险较低。医疗可及性和保险类型的差异可能会影响血管通路的类型。
