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Abstract(s)
Introdução: Com uma incidência em Portugal de 230 partes por milhão, a Insuficiência renal crónica terminal tem vindo a aumentar nos últimos anos não só em Portugal como a nível europeu. Com comorbilidades implicadas na sua etiologia, bem definidas e cada vez mais estudadas, têm, nos últimos anos, sido levantadas questões a nível dos estudos feitos, de não só a clínica ter implicação na sua progressão e desfecho mas que outros factores, nomeadamente sociais e económicos poderão ter influência. Considerada um problema de saúde pública mundial é cada vez mais importante explorar até que ponto o âmbito socioeconómico tem previsibilidade nos resultados obtidos com as terapias de substituição da função renal.
Os objetivos deste trabalho são: (i) caracterizar do ponto de vista socioeconómica a população de doentes em hemodiálise no Hospital Amato Lusitano nos últimos 10 anos e (ii) aferir a possível relação com a sobrevida dos mesmos doentes.
Materiais e Métodos: O estudo foi realizado no serviço de Nefrologia do Hospital Amato Lusitano, em Castelo Branco, por análise de coorte retrospetivo.
Foram incluídos todos os pacientes, com idade superior a 18 anos, que iniciaram hemodiálise no Hospital Amato Lusitano, no período de tempo entre janeiro de 2003 e dezembro de 2014. Os dados recolhidos foram referentes a: (i) isenção económica, (ii) incapacidade superior ou igual a 60% e/ou doente transplantado de órgão (iii) serem beneficiários de um subsistema de saúde que não o SNS, (iv) estado civil, (v) institucionalização e (vi) concelho.
Resultados: Dos 475 doentes estudados 62.7% eram do sexo masculino, com uma média de idades de 72.6 anos. A etiologia predominante foi a nefropatia diabética e a maioria era seguida em consulta de nefrologia prévia. A maioria da população era casada, 16.4% estavam institucionalizados, apenas 20.8% têm isenção económica e 9.3% outro tipo de isenção; uma minoria tem um subsistema de saúde que não o Serviço Nacional de Saúde e a maior percentagem dos doentes seguidos são provenientes de Castelo Branco e da Covilhã. Em termos de sobrevida verificou-se que existiam diferenças na sobrevida estatisticamente significativas para os doentes com isenções e para os institucionalizados. O grupo de doentes com isenção económica tem uma sobrevida ao fim de 5 anos de 72.6% comparado com o grupo dos não isentos com uma sobrevida de 40%; também a sobrevida dos classificados com outro tipo de isenção foi superior; já os doentes institucionalizados apresentam uma sobrevida ao fim de 5 anos de 23%, quase metade do que se verifica nos não institucionalizados. Quando realizada análise multivariada, verificou-se que as isenções, quer económica quer de outro tipo, quer a institucionalização têm influência na mortalidade aos 5 anos.
Conclusão: Neste trabalho concluiu-se que os factores socioeconómicos apresentam relevância estatística para a determinação de sobrevida dos pacientes em hemodiálise na Beira Interior. Os doentes institucionalizados continuam a apresentar resultados mais desfavoráveis e as isenções quer económica quer de outro tipo parecem ter um impacto positivo na sobrevida destes doentes.
Introduction: With an incidence in Portugal of 230 parts per million, over previously years, terminal renal disease has been increasing not only in Portugal but also in Europe. With comorbidities involved in its etiology, well defined and even more studied, there has been, in recent years, several studies and questions made, which not only have clinical implication in their progression and outcome but as well as in other factors, including social and economic influence. Considered a worldwide problem of public health and with the replacement therapy of renal function it is important to explore the extent to which the socio-economic sphere has predictability in the results obtained. Our main aims are: (i) to characterize the socio-economic characteristics of hemodialysis patients in the Hospital Amato Lusitano over the last 10 years and (ii) to assess the possible relationship with the survival of these patients. Materials and Methods: The study was conducted at the Nephrology department of the Hospital Amato Lusitano, in Castelo Branco, by the analysis of retrospective cohort. All of the patients included were older than 18 years, who started hemodialysis at the Hospital Amato Lusitano, in the period between January 2003 and December 2014. The collected data was related to: (i) tax exemption, (ii) greater than or equal to 60% disability and / or organ transplant patient (iii) being beneficiary of a health subsystem that is not the National Health Service, (iv) marital status, (v) institutionalization and (vi) district. Results: Of the 475 patients studied 62.7% were male, with an average age of 72.6 years old. The predominant cause was diabetic nephropathy and most were followed in previous nephrology appointments. Most of the patients were married, 16.4% were institutionalized, only 20.8% have economic exemption and 9.3% have other type of exemption; a minority have a health subsystem other than the National Health Service and the highest percentage of patients followed were from Castelo Branco and Covilhã. In terms of survival it was found that there were statistically significant differences in survival of patients and institutionalized exemptions. The group of patients with economic exemption has a survival at 5 years of 72.6% compared to the group of non-exempt with a survival rate of 40%; also the survival of classified with another type of exemption was higher; already institutionalized patients have a survival rate of 5 years at 23%, almost half of that found in the non-institutionalized. When performed a multivariate analysis, it was found that the exemption, both economically and of other types, and institutionalization influence on mortality by 5 years. Conclusion: In this study it was concluded that socio-economic factors have statistically significance in determining survival of hemodialysis patients in Beira Interior. The institutionalized patients continue to have worse outcomes and the exemption both economically and of other types seems to have a positive impact on the survival of these patients.
Introduction: With an incidence in Portugal of 230 parts per million, over previously years, terminal renal disease has been increasing not only in Portugal but also in Europe. With comorbidities involved in its etiology, well defined and even more studied, there has been, in recent years, several studies and questions made, which not only have clinical implication in their progression and outcome but as well as in other factors, including social and economic influence. Considered a worldwide problem of public health and with the replacement therapy of renal function it is important to explore the extent to which the socio-economic sphere has predictability in the results obtained. Our main aims are: (i) to characterize the socio-economic characteristics of hemodialysis patients in the Hospital Amato Lusitano over the last 10 years and (ii) to assess the possible relationship with the survival of these patients. Materials and Methods: The study was conducted at the Nephrology department of the Hospital Amato Lusitano, in Castelo Branco, by the analysis of retrospective cohort. All of the patients included were older than 18 years, who started hemodialysis at the Hospital Amato Lusitano, in the period between January 2003 and December 2014. The collected data was related to: (i) tax exemption, (ii) greater than or equal to 60% disability and / or organ transplant patient (iii) being beneficiary of a health subsystem that is not the National Health Service, (iv) marital status, (v) institutionalization and (vi) district. Results: Of the 475 patients studied 62.7% were male, with an average age of 72.6 years old. The predominant cause was diabetic nephropathy and most were followed in previous nephrology appointments. Most of the patients were married, 16.4% were institutionalized, only 20.8% have economic exemption and 9.3% have other type of exemption; a minority have a health subsystem other than the National Health Service and the highest percentage of patients followed were from Castelo Branco and Covilhã. In terms of survival it was found that there were statistically significant differences in survival of patients and institutionalized exemptions. The group of patients with economic exemption has a survival at 5 years of 72.6% compared to the group of non-exempt with a survival rate of 40%; also the survival of classified with another type of exemption was higher; already institutionalized patients have a survival rate of 5 years at 23%, almost half of that found in the non-institutionalized. When performed a multivariate analysis, it was found that the exemption, both economically and of other types, and institutionalization influence on mortality by 5 years. Conclusion: In this study it was concluded that socio-economic factors have statistically significance in determining survival of hemodialysis patients in Beira Interior. The institutionalized patients continue to have worse outcomes and the exemption both economically and of other types seems to have a positive impact on the survival of these patients.
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Keywords
Beira Interior Demografia Doença Renal Crónica Terminal Epidemiologia Hemodiálise