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[巴西米纳斯吉拉斯州透析中心在2015年至2019年将患者转诊并纳入肾移植前等待名单的表现分析]

[Analysis of the performance of dialysis centers in referring and enrolling patients into the pre-kidney transplant waiting list in Minas Gerais State, Brazil, 2015 to 2019].

作者信息

Pereira Cláudio Vitorino, Leite Isabel Cristina Gonçalves, Nogueira Mário Círio, Ferreira Gustavo Fernandes

机构信息

Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil.

Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, Brasil.

出版信息

Cad Saude Publica. 2025 Jan 27;41(1):e00021423. doi: 10.1590/0102-311XPT021423. eCollection 2025.

DOI:10.1590/0102-311XPT021423
PMID:39879397
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11774332/
Abstract

Despite the relevance of kidney transplantation, the supply of organs and the process for inclusion in its waiting list still represent obstacles. This study aimed to analyze the performance of dialysis centers in referring patients for pre-kidney transplant evaluation and inclusion in the waiting list of incident dialysis patients from 2015 to 2019 in the state of Minas Gerais, Brazil. This retrospective cohort study sampled 23,297 records of patients who underwent dialysis therapy in public or philanthropic institutions or who had their treatment funded by the Brazilian Unified National Health System in private clinics. Survival analysis by the Kaplan-Meier method was used to evaluate pre-kidney transplant referral. The strength of the association between the exposure variables and the occurrence of inclusion on the list were analyzed by Cox regression models. Only 14.8% of the sample was enrolled on the pre-kidney transplant waiting list. The cumulative probability of enrollment totaled 1.2% in 180 days and 3.3% in one year from 2016 to 2019. Northern Minas Gerais had the highest cumulative probability of enrollment on the waiting list, whereas its South, the lowest. Adult individuals were more likely to be enrolled than older adults, and enrollment was more likely in 2016 than in 2018 and 2019. Although Ordinance n. 389/2014 from the Brazilian Ministry of Health established the minimum percentage of eligible patients that must be included in the list, this study observed no positive repercussion on the accumulated probability of enrollment in dialysis incidents in subsequent years.

摘要

尽管肾移植意义重大,但器官供应以及进入等待名单的流程仍然是障碍。本研究旨在分析巴西米纳斯吉拉斯州透析中心在2015年至2019年期间将患者转介进行肾移植前评估并纳入新透析患者等待名单的表现。这项回顾性队列研究抽取了23297例患者的记录,这些患者在公立或慈善机构接受透析治疗,或其治疗由巴西统一国家卫生系统在私立诊所提供资金。采用Kaplan-Meier方法进行生存分析以评估肾移植前转介情况。通过Cox回归模型分析暴露变量与列入名单事件发生之间的关联强度。样本中只有14.8%的患者被列入肾移植前等待名单。2016年至2019年期间,180天内登记的累积概率总计为1.2%,一年中的累积概率为3.3%。米纳斯吉拉斯州北部在等待名单上登记的累积概率最高,而南部最低。成年人比老年人更有可能被登记,2016年的登记可能性高于2018年和2019年。尽管巴西卫生部第389/2014号法令规定了必须列入名单的合格患者的最低百分比,但本研究未观察到对随后几年透析事件登记累积概率产生积极影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bf8/11774332/5e5053362a68/1678-4464-csp-41-01-PT021423-gf2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bf8/11774332/2803d10737d8/1678-4464-csp-41-01-PT021423-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bf8/11774332/5e5053362a68/1678-4464-csp-41-01-PT021423-gf2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bf8/11774332/2803d10737d8/1678-4464-csp-41-01-PT021423-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bf8/11774332/5e5053362a68/1678-4464-csp-41-01-PT021423-gf2.jpg

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本文引用的文献

1
Spatial analysis of care for patients undergoing dialysis therapy in the state of Minas Gerais, Brazil, between 2015 and 2019.巴西米纳斯吉拉斯州 2015 年至 2019 年透析治疗患者护理的空间分析。
Rev Bras Epidemiol. 2024 Jan 19;27:e240002. doi: 10.1590/1980-549720240002. eCollection 2024.
2
Gender Disparities in Kidney Transplantation Referral Vary by Age and Race: A Multiregional Cohort Study in the Southeast United States.肾脏移植转诊中的性别差异因年龄和种族而异:美国东南部的一项多区域队列研究
Kidney Int Rep. 2022 Apr 5;7(6):1248-1257. doi: 10.1016/j.ekir.2022.03.027. eCollection 2022 Jun.
3
Kidney transplantation or dialysis in older adults-an interview study on the decision-making process.
老年患者的肾移植或透析治疗——一项关于决策过程的访谈研究。
Age Ageing. 2022 Jun 1;51(6). doi: 10.1093/ageing/afac111.
4
Barriers and Solutions to Kidney Transplantation for the Undocumented Latinx Community with Kidney Failure.无证拉丁裔肾衰竭患者肾移植的障碍与解决方案
Clin J Am Soc Nephrol. 2021 Oct;16(10):1587-1589. doi: 10.2215/CJN.03900321. Epub 2021 Sep 23.
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Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease.按肾脏疾病病因划分的 deceased-donor 肾脏移植机会的性别差异。
Clin J Am Soc Nephrol. 2021 Feb 8;16(2):241-250. doi: 10.2215/CJN.09140620. Epub 2021 Jan 26.
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Using Geographic Catchment Areas to Measure Population-based Access to Kidney Transplant in the United States.利用地理服务区衡量美国基于人群的肾移植服务可及性
Transplantation. 2020 Dec;104(12):e342-e350. doi: 10.1097/TP.0000000000003369.
7
Sex disparities in dialysis initiation, access to waitlist, transplantation and transplant outcome in German patients with renal disease-A population based analysis.德国肾脏病患者透析起始、进入候补名单、移植和移植结局的性别差异:一项基于人群的分析。
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