ABSTRACT
INTRODUCTION AND OBJECTIVES: Chronic kidney disease has a high prevalence and economic impact, and an increased risk of hospitalization. Although there are public regional and country registries, we have not found references to estimate the impact of renal replacement therapy (RRT) on hospital admissions. METHODS: We obtained authorization from the ethics committee and health authorities to integrate the REMER [Madrid Kidney Disease Registry] (2013-2014) and Minimum Basic Data Set (2013-2015) databases and to analyze the admissions during the first year of RRT. RESULTS: 767 patients started RRT in all the hospitals of our region across all RRT modalities. More than a third of the patients start dialysis during a hospital admission. This unplanned start, more common in HD than PD, shows relevant differences in patient profile or admission characteristics. Without considering this initial episode, almost 60% of patients were admitted during their first year. The hospitalization rate was 1.2admissions/patient, higher in HD than in TX or PD; the mean length of stay was 8.6days. The estimated cost of admissions during the first year is 12,006/patient. Our analysis ensures the exhaustive inclusion of all episodes and accurate estimation based on the discharge form. CONCLUSION: The impact of RRT on hospitals has been underestimated and is very relevant when calculating the total cost of RRT. Results from other countries cannot be extrapolated due to differences in the health system and patient profile. The integration of clinical databases could open up an opportunity that needs only institutional support for its development.
Subject(s)
Hospitalization/statistics & numerical data , Kidney Failure, Chronic/therapy , Renal Replacement Therapy , Adult , Aged , Cohort Studies , Delivery of Health Care , Female , Humans , Male , Middle Aged , Public Health , Spain , Time FactorsABSTRACT
Describimos la población de los afiliados del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados de Buenos Aires (INSSJP), mayores de 75 años, en las diferentes modalidades de terapia sustitutiva renal. Se identificaron en el Sistema Nacional de Información de Procuración y Trasplante de la República Argentina (SINTRA) todos los afiliados mayores de 75 años que iniciaron terapia dialítica entre el 01/01/2011 y el 31/12/2015, y todos los mayores de 75 años que recibieron un trasplante renal en ese período. Un total de 3989 pacientes iniciaron terapia dialítica en dicho período. De ellos sólo 67 (1.7%) lo hicieron en diálisis peritoneal, 11 (0.3%) se inscribieron en lista de espera, y sólo 2 recibieron un trasplante renal. Se observó un aumento de la incidencia de pacientes de ese grupo etario, del 2011 al 2015 del 7% aproximadamente. Cuarenta pacientes mayores de 75 años recibieron un trasplante, veintidós de ellos (55%) se encontraban inscriptos en el Programa Old for Old. La mediana de sobrevida fue de 3.9 años (IC 95% 1.5 a 3.93) para los pacientes trasplantados. Al momento del fallecimiento, el 66% tenían injerto funcionante. La mediana de sobrevida en hemodiálisis fue 1.53 años (IC 95% 1.43 a 1.63), y 2.02 (IC 95% 1.5 a 3.2) en diálisis peritoneal. No hubo diferencias estadísticamente significativas entre hemodiálisis, diálisis peritoneal y trasplante, aunque se observó una supervivencia levemente mayor en esta última. En nuestro país es despreciable la cantidad de pacientes mayores de 75 años que acceden a diálisis peritoneal y trasplante, aunque de acuerdo a la bibliografía analizada, podría ser una muy buena opción de tratamiento para los mismos y consideramos que debería ampliarse su utilización
We describe the population of the affiliates of the National Institute of Social Services for Retirees and Pensioners of Buenos Aires (INSSJP), older than 75 years, in the different modalities of renal replacement therapy. All affiliates older than 75 who started dialysis therapy between 01/01/2011 and 12/31/2015 were identified in the National System of Procurement and Transplantation of the Argentine Republic (SINTRA), as well as all those older than 75 who received a kidney transplant in that period. A total number of 3989 patients started dialysis treatment during that period. Only 67 of them (1.7%) underwent peritoneal dialysis (PD); 11 (0.3%) were on the waiting list and just 2 of them received a kidney transplant. An increase of about 7% in the incidence of patients belonging to this age group was observed between 2011 and 2015. Forty patients older than 75 received a transplant, twenty-two of them (55%) were enrolled in the Old for Old Program. The median survival for patients who had had a transplant was 3.9 years (95% CI 1.5 to 3.93). At the time of death, 66% of them had a functioning graft. The median survival for hemodialysis was 1.53 years (95% CI 1.43 to 1.63), and 2.02 (95% CI 1.5 to 3.2) for peritoneal dialysis. There were no statistically significant differences among hemodialysis, peritoneal dialysis and transplantation, although a slightly higher survival was observed in the latter. In our country the number of patients older than 75 who access peritoneal dialysis and transplantation is negligible, although according to the publications analyzed, it could be a good treatment option for them and we believe that their use should be expanded
