Modalidades de terapia renal substitutiva

Este recurso educacional integra o conjunto de objetos autoinstrucionais ofertados pela UNA-SUS/UFMA na área temática de Nefrologia. Trata-se de um e-book que apresenta as modalidades de terapia renal substitutiva, abordando as indicações e contraindicações para cada uma delas. Desta forma, espera-se que o leitor possa conhecer as principais complicações destes métodos. Além deste, há mais 31 e-books tratando sobre diversas questões relacionadas à Nefrologia. Todos eles fornecem conteúdos interessantes para a formação dos profissionais da saúde que atuam no SUS e dos acadêmicos da área.

Terapia renal substitutiva

Este recurso educacional integra o conjunto de objetos na área temática de Nefrologia, ofertados pela UNA-SUS/UFMA. Trata-se de um recurso autoinstrucional, com carga horária sugerida de 30 horas. O curso é composto por 3 unidades educacionais com o objetivo de capacitar os profissionais da saúde que atuam ou que pretendem atuar na Atenção Básica. São abordados temas como as modalidades de terapia renal substitutiva e suas principais complicações; o transplante renal como modalidade de terapia renal substitutiva; a legislação para transplantes de órgãos; a importância da família no cuidado ao paciente com doença renal crônica.

Manejo clínico das doenças renais

Busca-se descrever estratégias para o manejo das doenças renais considerando as suas formas de controle, tratamento e complicações associadas. Este recurso educacional integra o conjunto de objetos na área temática de Nefrologia, ofertados pela UNA-SUS/UFMA. Trata-se de um recurso autoinstrucional, com carga horária sugerida de 45 horas, composto por 3 unidades, com o objetivo de capacitar os profissionais da saúde que atuam ou que pretendem atuar na Atenção Básica

Overview of hemodialysis treatment funded by the Brazilian Unified Health System--An economic perspective.

INTRODUCTION: End-stage renal disease (ESRD) is a public health problem and, in Brazil, lacks of data on one of the main treatments, hemodialysis, are still identified. OBJECTIVE: To determine, through description of resources used in ESRD treatment and its complications, the cost associated to hemodialysis and supplementary medical therapy in patients attended by Brazilian Public Health (SUS). METHODS: Methods of cross-sectional and prospective cohort observational analysis were conducted using public data, where information about inpatient and outpatient resource use and patients' characteristics were collected. From described resource use, costs were calculated. In cross-sectional analysis subjects who underwent hemodialysis between January/2008 and November/2012 were considered and in prospective cohort, started in 2009. Descriptive analyses were performed. RESULTS: 91,475 and 118,847 hemodialysis procedures were performed in 2008 and 2012, respectively, and 24.8% of increase was estimated until 2017. Analysis by federation unit showed that São Paulo, Minas Gerais and Rio de Janeiro states represented almost half of the procedures observed, with mean cost per patient of US$ 7,932.52 in 2008 and US$ 9,112.75 in 2011. In the cohort, composed by 96,600 subjects, the most used drug was alfaepoetin and 8% of the sample used calcitriol 1.0 mcg. The occurrence of complications was observed in 28.2% of patients. CONCLUSION: After data analysis, different aspects of hemodialysis use were demonstrated, with an increase in amount of procedures and, also, in disease related expenses.

Panorama do tratamento hemodialítico financiado pelo Sistema Único de Saúde - Uma perspectiva econômica / Overview of hemodialysis treatment funded by the Brazilian Unified Health System - An economic perspective

ResumoIntrodução:A doença renal crônica (DRC) é um problema de saúde pública e, no Brasil, ainda são identificadas carências de dados sobre características de um dos principais tratamentos, a hemodiálise.Objetivo:Determinar, por meio da descrição do consumo de recursos para o tratamento e suas complicações, o custo associado à hemodiálise e às terapias medicamentosas suplementares em pacientes financiados pelo SUS.Métodos:Métodos de análise observacional transversal e coorte prospectiva foram utilizados considerando dados públicos, dos quais foram coletadas informações referentes a procedimentos hospitalares e ambulatoriais, além de características dos pacientes. Os custos foram calculados a partir dos recursos descritos. Na análise transversal foram considerados indivíduos que realizaram hemodiálise entre janeiro de 2008 e novembro de 2012 e na coorte prospectiva, iniciada em 2009. Análises descritivas foram conduzidas.Resultados:Um total de 91.475 e 118.847 procedimentos de hemodiálise foram realizados em 2008 e 2012, respectivamente, e, para o ano 2017, foi estimado um aumento de 24,8%. A análise por unidade federativa mostrou que São Paulo, Minas Gerais e Rio de Janeiro representam quase metade dos procedimentos, com média de custo, por paciente, de US$ 7.932,52 em 2008, e de US$ 9.112,75 em 2011. Na coorte, composta por 96.600 indivíduos, o medicamento mais utilizado foi a alfapoetina, além de 8% da amostra utilizar calcitriol 1,0 mcg. Foi observada a ocorrência de complicações em 28,2% dos pacientes.Conclusão:Após análise dos dados, diferentes aspectos da utilização da hemodiálise foram demonstrados, sendo observado um aumento na quantidade de procedimentos e, também, nos gastos decorrentes do procedimento.

AbstractIntroduction:End-stage renal disease (ESRD) is a public health problem and, in Brazil, lacks of data on one of the main treatments, hemodialysis, are still identified.Objective:To determine, through description of resources used in ESRD treatment and its complications, the cost associated to hemodialysis and supplementary medical therapy in patients attended by Brazilian Public Health (SUS).Methods:Methods of cross-sectional and prospective cohort observational analysis were conducted using public data, where information about inpatient and outpatient resource use and patients' characteristics were collected. From described resource use, costs were calculated. In cross-sectional analysis subjects who underwent hemodialysis between January/2008 and November/2012 were considered and in prospective cohort, started in 2009. Descriptive analyses were performed.Results:91,475 and 118,847 hemodialysis procedures were performed in 2008 and 2012, respectively, and 24.8% of increase was estimated until 2017. Analysis by federation unit showed that São Paulo, Minas Gerais and Rio de Janeiro states represented almost half of the procedures observed, with mean cost per patient of US$ 7,932.52 in 2008 and US$ 9,112.75 in 2011. In the cohort, composed by 96,600 subjects, the most used drug was alfaepoetin and 8% of the sample used calcitriol 1.0 mcg. The occurrence of complications was observed in 28.2% of patients.Conclusion:After data analysis, different aspects of hemodialysis use were demonstrated, with an increase in amount of procedures and, also, in disease related expenses.

Modalidades de terapia renal substitutiva: hemodiálise e diálise peritoneal

Neste vídeo, o Dr. Roberto Flávio Pecoits Filho explica as características de cada modalidade do tratamento dialítico, a diálise peritoneal e hemodiálise. A primeira é realizada na casa do paciente, necessitando de treinamento para os familiares, uma adequada comunicação à distância com a equipe médica e armazenamento correto do material. Já a hemodiálise é realizada em uma clínica com equipamento e equipe especializada. Ambas necessitam de atenção redobrada às complicações, que podem culminar em problemas cardiovasculares.

The relationship between ultrafiltrate volume with icodextrin and peritoneal transport pattern according to the peritoneal equilibration test.

OBJECTIVE: To establish a relationship between peritoneal transport membrane pattern, analyzed by the peritoneal equilibration test (PET), and drained volume using icodextrin (7.5% Ico) and glucose (3.86% Glu) solutions. DESIGN: Thirty peritoneal dialysis patients were submitted to a standard 4-hour PET and divided into 4 transport categories based on dialysate-to-plasma ratio of creatinine (D/Pcr) and dialysate ratio of glucose at 4 and zero hours of the dwell (D4/D0). Patients were asked to perform exchanges for 2 consecutive nights in 10-hour dwells (2 L 3.86% Glu solution on the first night, and 2 L 7.5% Ico solution on the second night). The drained volume was measured and dialysate samples from the overnight exchanges were obtained for beta2-microglobulin (B2M) levels. RESULTS: PET classification using D/Pcr showed that 46.6% of the patients were high and high-average transporters, or 23.3% when D4/D0 was used. In spite of this difference, both methods showed significant correlation (p = 0.0001, r = 0.862). The mean drained volumes were similar for both solutions (for 3.86% Glu, 2696 +/- 369 mL; for 7.5% Ico, 2654 +/- 424 mL). The high and high-average transport patients classified by D4/D0 achieved a higher ultrafiltration with 7.5% Ico than with 3.86% Glu (p = 0.0235). When classified by D/Pcr, the difference was not significant (p = 0.2243). In the low and low-average transport patients classified by D/Pcr, we observed a significantly lower ultrafiltration when 7.5% Ico was used compared to 3.86% Glu solution (p = 0.0197). Using D4/D0, we saw a tendency toward lower ultrafiltration (p = 0.0719) in the same group. We then correlated the PET results and the difference between drained volume with 7.5% Ico and 3.86% Glu solution [deltaV (I-G)]. We found a significant negative correlation between D4/D0 and deltaV (I-G) (p = 0.002, r = -0.5390), and a positive correlation between D/Pcr and deltaV (I-G) (p = 0.005, r = 0.4932). The levels of B2M obtained with 7.5% Ico were higher than those obtained with 3.86% Glu solution (for 7.5% Ico, 9.47 +/- 6.71 microg/vol; for 3.86% Glu, 7.29 +/- 4.91 microg/vol; p = 0.004). Furthermore, we found significant correlation between the total amount of B2M obtained with 7.5% Ico solution and D4/D0 (p < 0.0001, r = -0.4493), and D/Pcr (p < 0.0001, r = 0.5431). CONCLUSION: Mean drained volume was similar between the two solution groups. High transporters, as defined by D4/D0, achieved higher ultrafiltration with 7.5% Ico than with 3.86% Glu solution. This is most likely due to the higher number of small pores in the peritoneal membrane. Low transporters, as classified by D/Pcr, achieved lower ultrafiltration with 7.5% Ico than with 3.86% Glu solution. The deltaV (I-G) and the PET results showed significant correlation, confirming that high transporters have a higher ultrafiltration volume with 7.5% Ico. The total B2M mass obtained with 7.5% Ico was greater than with 3.86% Glu solution and significantly higher in the high transport patients, indicating a larger number of small pores. Thus, the deltaV (I-G) could give us an idea of the peritoneal transport pattern in peritoneal dialysis patients.