title: Allocation of initial modality for renal replacement therapy in Brazil.
abstract: OBJECTIVE
  The use of dialysis modalities for ESRD varies around the world. There is no consensus in literature regarding the most appropriate choice of dialysis method. The aim of this study was to analyze the initial modality for ESRD in Brazil and evaluate the factors determining patients' allocation to either hemodialysis (HD) or peritoneal dialysis (PD).
  
  
  METHODS
  A retrospective cohort study was performed using national administrative registries of all patients financed by the public system who began renal replacement therapy in 2000 in Brazil. Logistic regression analysis was used to investigate factors associated with the probability of receiving HD or PD at the start of treatment. Independent variables tested were age, sex, presence of diabetes, geographic region of residence, and health care supply indicators.
  
  
  RESULTS
  Of 11,563 patients analyzed, 88% started on HD and 12% started on PD. Patients were more likely to be assigned to HD if they were male (odds ratio: 1.44; 95% confidence interval: 1.23 to 1.68) and nondiabetic (odds ratio: 0.71; 95% confidence interval: 0.60 to 0.84). With regard to age, the youngest and the elderly showed lower probability of being in HD. In addition, the state of residence at the start of treatment was very important to explain initial modality allocation.
  
  
  CONCLUSIONS
  Our findings suggest that patient allocation in Brazil is not random. The probability of allocation to HD or PD is highly associated with individual attributes and supply variables.
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, sala 706, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Mônica Viegas
authors.initials: MV
authors.lastname: Andrade
authors.forename: Jaume Puig
authors.initials: JP
authors.lastname: Junoy
authors.forename: Eli Iola Gurgel
authors.initials: EI
authors.lastname: Andrade
authors.forename: Francisco de Assis
authors.initials: Fde A
authors.lastname: Acurcio
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sesso
authors.forename: Odilon Vanni de
authors.initials: OV
authors.lastname: Queiroz
authors.forename: Daniele Araújo
authors.initials: DA
authors.lastname: Szuster
authors.forename: Isabel Cristina
authors.initials: IC
authors.lastname: Gomes
authors.forename: Alessandra Maciel
authors.initials: AM
authors.lastname: Almeida
authors.forename: Mariangela Leal
authors.initials: ML
authors.lastname: Cherchiglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult