Improving the management of chronic kidney disease in Uruguay: a National Renal Healthcare Program.
BACKGROUND
Uruguay has implemented a chronic kidney disease (CKD) prevention program.


OBJECTIVE
The objectives of the study are to assess the results of the National Renal Healthcare Program (NRHP).


METHODS
This study is a cohort study of nondialysis-registered patients from October 2004 to March 2008. We made a comparison between patients under nephrology care (NC) or the care of a primary care physician (PCP; prereferral). In the outcome analysis, the primary endpoint was end-stage renal disease (ESRD) and the secondary endpoints were progression of CKD, compliance with the therapeutic goals and death. ESRD/mortality predictors were determined by Cox analysis.


RESULTS
The study comprised 2,219 patients aged 67.4 +/- 13.5 years, of whom 52.5% were male, 42.1% hypertensive, 16.9% had diabetic nephropathy, and 61.3 and 21.4% were in CKD stages III and IV, respectively. At baseline, NC patients showed a better control than patients under the care of a PCP: systolic blood pressure > or =160 mm Hg (22.4 vs. 31.1%); total cholesterol <5.8 mmol/l (56.6 vs. 42.5%); and low-density lipoprotein cholesterol <2.9 mmol/l (41.2 vs. 29.1%). Control improved in patients under the care of a PCP according to years of enrollment. Outcome analysis (1,188 patients) showed a significant improvement in targets, with 56% of the patients stabilizing. CKD stage IV, diabetic nephropathy, proteinuria and hypertension increased the risk of ESRD; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and age <65 years decreased the risk.


CONCLUSIONS
Our results highlight the best management of CKD patients in both groups and the impact of the NC and renin-angiotensin-aldosterone system blockers.
Schwedt
Emma
E
Honorary Committee of Renal Healthcare, Montevideo, Uruguay. eschwedt54@gmail.com
Solá
Laura
L
Ríos
Pablo G
PG
Mazzuchi
Nelson
N
D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy; D012307:Risk Factors; D016896:Treatment Outcome; D014583:Uruguay / Q000453:epidemiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors