Gemente Douglas Vieira, Bacci Marcelo Rodrigues
Nephrology Division, Hospital Santa Marcelina, São Paulo (SP), Brazil; Centro Universitário Faculdade de Medicina do ABC (FMABC), Santo André (SP), Brazil.
Assistant Professor, General Practice Department, Post-Graduation Program, Centro Universitário Faculdade de Medicina do ABC (FMABC), Santo André (SP), Brazil.
Sao Paulo Med J. 2024 Dec 20;143(1):e2023365. doi: 10.1590/1516-3180.2023.0365.R1.03072024. eCollection 2024.
Universal healthcare is a cornerstone of Brazil's public health system. However, delayed diagnosis and treatment of chronic kidney disease (CKD) remain substantial issues. The scarcity of outpatient dialysis facilities contributes to extended hospital stays. This study aimed to examine how the time to dialysis initiation (TID) impacts mortality in patients with renal disease.
This study aimed to evaluate the correlation between variables affecting TID and mortality in hospitalized patients with renal disease.
A cross-sectional study was conducted at Santa Marcelina Hospital in São Paulo.
This cross-sectional study was conducted in a tertiary hospital, involving adults with kidney disease who were referred to the emergency department between 2014 and 2017. Primary outcomes included TID and mortality rates.
Among the 402 patients studied, the average age was 58.6 years, and 59.4% were men. The median hospital stay was 44.5 d. Notably, 28.1% of the patients began dialysis under emergency conditions. Diabetes and hypertension were the most prevalent causes of renal disease. A positive correlation was found between age and TID (P = 0.007).
Primary care in Brazil often fails to effectively detect and manage CKD, leading to a higher incidence of emergency dialysis, particularly among older adults. This delay correlates with increased mortality rates. Older age is associated with delayed TID, prolonged hospital stays, and consequently higher mortality. These findings highlight the need for better primary care to effectively manage CKD and reduce hospitalization and mortality.
全民医保是巴西公共卫生系统的基石。然而，慢性肾脏病（CKD）的诊断和治疗延迟仍是重大问题。门诊透析设施的短缺导致住院时间延长。本研究旨在探讨开始透析时间（TID）如何影响肾病患者的死亡率。
本研究旨在评估影响TID的变量与住院肾病患者死亡率之间的相关性。
在圣保罗的圣马塞利纳医院进行了一项横断面研究。
这项横断面研究在一家三级医院开展，纳入了2014年至2017年间转诊至急诊科的成年肾病患者。主要结局包括TID和死亡率。
在研究的402例患者中，平均年龄为58.6岁，59.4%为男性。中位住院时间为44.5天。值得注意的是，28.1%的患者在紧急情况下开始透析。糖尿病和高血压是肾病最常见的病因。年龄与TID之间存在正相关（P = 0.007）。
巴西的初级保健往往未能有效检测和管理CKD，导致紧急透析的发生率较高，尤其是在老年人中。这种延迟与死亡率增加相关。年龄较大与TID延迟、住院时间延长以及因此更高的死亡率相关。这些发现凸显了需要更好的初级保健来有效管理CKD并降低住院率和死亡率。
