Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center.
BACKGROUND
Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD) outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV).


OBJECTIVE
To analyze the impact of SV on the outcomes of predialysis patients.


METHODS
Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009) in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT).


RESULTS
Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23) or need for RRT (log rank: 0.17). In the Cox regression model, the hazard ratios (HRs) for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41) and 1.47 (CI: 0.35-6.0), respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8) and 2.19 (CI: 0.50-9.6), respectively.


CONCLUSIONS
These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center.
Universidade Federal de Juíz de Fora, Brasil.
Luciana dos Santos
Ldos S
Tirapani
Universidade Federal de Juíz de Fora, Brasil.
Hélady Sanders
HS
Pinheiro
Fundação Instituto Mineiro de Ensino e Pesquisas em Nefrologia, Brasil.
Henrique Novais
HN
Mansur
Fundação Instituto Mineiro de Ensino e Pesquisas em Nefrologia, Brasil.
Dilmerson de
Dd
Oliveira
Fundação Instituto Mineiro de Ensino e Pesquisas em Nefrologia, Brasil.
Rosália Maria Nunes Henriques
RM
Huaira
Fundação Instituto Mineiro de Ensino e Pesquisas em Nefrologia, Brasil.
Carlos Contreras
CC
Huaira
Fundação Instituto Mineiro de Ensino e Pesquisas em Nefrologia, Brasil.
Fabiane Rossi dos Santos
FR
Grincenkov
Universidade Federal de Juíz de Fora, Brasil.
Marcus Gomes
MG
Bastos
Universidade Federal de Juíz de Fora, Brasil.
Natália Maria da Silva
NM
Fernandes
D000368:Aged; D001938:Brazil; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome