title: [Fatality and hospitalization in hemodialysis patients in a health plan].
abstract: OBJECTIVE
  To analyze clinical outcomes of patients on hemodialysis linked to health care plan provider.
  
  
  METHODS
  Cohort study of hemodialysis events in Belo Horizonte, MG, Southeastern Brazil, between 2004 and 2008, based on records from health care plan provider databases. The independent variables were: sex, age, time between first appointment with nephrologist and starting hemodialysis, type of first vascular access, diabetes mellitus, length of time spent in hospital/year of treatment and death.
  
  
  METHODS
  time between starting hemodialysis and death and length of time spent in hospital/year of treatment > 7.5 days. Statistical analysis was carried out using Pearson's Chi-squared test in the univariate analysis for the outcomes 'death' and 'length of time spent in hospital/year of treatment'; the Kaplan-Meier method was used to analyze survival; the Cox model and Poisson regression were used for risk of death and chance of length of time spent in hospital/year of treatment > 7.5 days. The Business Intelligence tool and Stata(r) 10.0 software were used to extract data.
  
  
  RESULTS
  There were 311 patients on hemodialysis included in the study, with a mean age of 62 (sd 16.6 years), of whom 55.5% were male. Prevalence increased 160% during the period in question. Survival analysis showed a higher mortality among older patients, patients that did not consult a nephrologists, those whose first vascular access was using a temporary catheter, those with diabetes mellitus, those admitted to hospital within a month of beginning hemodialysis. The Cox model showed that a higher risk of death was associated with age, diabetes mellitus, not consulting a nephrologists and those that were hospitalized within a month of beginning hemodialysis. Greater length of time spent in hospital/year of treatment was not associated with sex or diabetes. According to Poisson regression, the variables were not significant.
  
  
  CONCLUSIONS
  Assessment by a specialist before starting hemodialysis decreases the risk of death in cases of chronic kidney disease, whereas the presence of diabetes and being hospitalized within a month of beginning hemodialysis are markers of risk of death.
authors.forename: Sérgio Adriano Loureiro
authors.initials: SA
authors.lastname: Bersan
authors.forename: Carlos Faria Santos
authors.initials: CF
authors.lastname: Amaral
authors.forename: Isabel Cristina
authors.initials: IC
authors.lastname: Gomes
authors.forename: Mariângela Leal
authors.initials: ML
authors.lastname: Cherchiglia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D048909:Diabetes Complications; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017061:Prepaid Health Plans / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D055815:Young Adult