Brabo Alexandre Minetto, Dias Dayana Bitencourt, Silva Everton Nunes da, Ponce Daniela
Universidade Estadual Paulista, Faculdade de Medicina, Departamento de Clínica Médica, Botucatu, SP, Brazil.
Universidade de Brasília, Departamento de Saúde Coletiva, Brasília, DF, Brazil.
J Bras Nefrol. 2025 Jan-Mar;47(1):e20240051. doi: 10.1590/2175-8239-JBN-2024-0051en.
Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD; however, the literature lacks such analyses when initiation is urgent.
To clinically and economically evaluate, from the perspective of the Unified Health System (SUS, Sistema Único de Saúde), the strategy of initiating unplanned RRT using HD or PD in patients during their first year of therapy.
Quasi-experimental study with cost-effectiveness analysis based on primary data from incident patients on RRT, over a twelve-month follow-up period, using the intention-to-treat approach. Data collection occurred prospectively, directly from medical records, computing data on the use of dialysis therapy, high-cost medications, procedures in dialysis accesses and recorded events. Costs were estimated using the amounts reimbursed by the SUS. In the economic analysis, the application of the bootstrap method and the construction of graphical representations were proposed.
At the end of one year, there were no differences between costs and effectiveness when initiating unplanned RRT using either PD or HD.
Starting RRT with PD is a similar option to starting with HD in patients requiring unplanned methods. The minimal initial investment required to establish PD slots makes it a strong option as a public health policy for expanding RRT in developing countries.
慢性肾脏病（CKD）患者中，无计划地启动肾脏替代治疗（RRT）在全球都是一种常见情况。在这种情况下，与血液透析（HD）相比，腹膜透析（PD）已成为一种治疗选择。在计划性RRT中，PD的成本低于HD；然而，在紧急启动治疗时，文献中缺乏此类分析。
从统一卫生系统（SUS，Sistema Único de Saúde）的角度，对在治疗的第一年中使用HD或PD启动无计划RRT的患者策略进行临床和经济评估。
基于RRT新发病例的原始数据进行成本效益分析的准实验研究，采用意向性分析方法，进行为期十二个月的随访。数据收集是前瞻性的，直接来自医疗记录，计算透析治疗的使用、高成本药物、透析通路的操作以及记录事件的数据。成本使用SUS报销的金额进行估算。在经济分析中，提出了应用自助法和构建图形表示。
在一年结束时，使用PD或HD启动无计划RRT时，成本和有效性之间没有差异。
对于需要无计划方法的患者，以PD开始RRT与以HD开始是类似的选择。建立PD治疗位所需的初始投资最小，这使其成为发展中国家扩大RRT的公共卫生政策的有力选择。
