Allocation of initial modality for renal replacement therapy in Brazil.
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.
Andrade
Mônica Viegas
MV
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.
Junoy
Jaume Puig
JP
Andrade
Eli Iola Gurgel
EI
Acurcio
Francisco de Assis
Fde A
Sesso
Ricardo
R
Queiroz
Odilon Vanni de
OV
Szuster
Daniele Araújo
DA
Gomes
Isabel Cristina
IC
Almeida
Alessandra Maciel
AM
Cherchiglia
Mariangela Leal
ML
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