Criteria for selection of ESRD treatment modalities

Abstract

Criteria for selection of ESRD treatment modalities. The most strategy may be based, also, on clinical status, patient important renal replacement therapies (RRT) for end-stage age, patient preference, psychological stability, etiology renal disease (ESRD) patients are hemodialysis (HD), peritoof ESRD, comorbidity, suitable living-related donor, neal dialysis (PD) and renal transplantation (RT). Survival, economic factors and social circumstances. morbidity and quality of life are the main factors to select the best RRT modality for a particular patient. The outcome comparison suggest that RT is a better overall treatment for DIALYSIS VS. RENAL TRANSPLANTESRD patients. On the other hand, the studies that compared patient outcome for HD and PD have yielded conflicting re-Patient survival after RT is markedly better than that sults. Neither treatment modality is best suited for all patients.seen with either HD or PD [1][2][3][4]. However, some of the The choice should be analyzed for each particular patient conbenefits associated with transplantation are related to sidering his demographic and comorbid conditions. Diabetic patient selection, since dialysis patients with the most patients, patients with cardiovascular disease and elderly patients are high risk populations and they are discussed indepenserious comorbid conditions are not accepted for the dently. The frequency of treatment modalities in the different transplant waiting list and hence remain in the dialysis countries is not in accordance with the analysis of the advangroup. Some comparative studies of dialysis vs. RT surtages and disadvantages of each one. Non-medical reasons vival have considered that the transplant group is favored are important factors in dialysis modality selection. In our experience the expertise of the nephrologic team is the most by inclusion of these high-risk patients in the dialysis important one. RT, HD and PD should not be seen as competgroup [2, 3, 5, 6].ing therapeutic options, rather, they are complementary meth-We analyzed survival for ESRD patients on dialysis ods of dealing with uremia. An integrated approach combining vs. after transplantation, adjusting for the variables that HD, PD and RT is necessary to devise an individualized treatwere significantly and independently related with mortalment program permitting optimal long-term physical and psychological well being and adequate integration in the family ity [7]. This analysis concluded that, when the outcome and society.is adjusted to comorbid factors, there are no differences between RT recipients' and HD patients' survival in nondiabetic patients, while RT gives better survival than HD Technological and immunological developments within in diabetics patients. Overall survival was significantly the last two decades have evolved several renal replacehigher in RT recipients than in HD patients (P Ͻ 0.0001). ment therapy (RRT) options. The most important of However, treatment modality did not show a significant them in the treatment of end-stage renal disease (ESRD...

Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

“…In the United States, in 1996, patients with 65 years or more were 46% of new patients on renal replacement therapy. 10 Despite not being the main primary cause of CKD, diabetes accounts for a greater proportional contribution for patients that began PD than those that in hemodialysis, suggesting a differential allocation of patients between these modalities. In developed countries, the patients on PD are more autonomous, have higher schooling, perform better preparation before initiating RRT and have less comorbidities.…”

“…Death was considered as a fi nal event, and the patients were only censored through loss of follow up or at the end of the study period. 10 In order to indentify an effect independent of the explanatory variables for survival, a multivariate Cox proportional hazard model was used. The proportionality assumption was evaluated by the graphic logminus-log method.…”

Allocation of Initial Modality for Renal Replacement Therapy in Brazil

“…First, patient characteristics are oped countries. Although some clinical conditions should be considered when allocating patients to either HD or PD (19), studies worldwide have shown that there are other factors that are quite important. These include patients' preferences, education, and training of physicians and nurses, as well as nonclinical factors such as financing, reimbursement, resource availability, and sociocultural habits.…”

“…Diabetic, youngest, and oldest patients had a greater probability of being allocated to PD. In the United States, PD allocation is more closely associated with younger individuals, whereas in France it is a common treatment option for the elderly (2,19,23,24).…”

Sobrevida de pacientes em diálise no SUS no Brasil

“…Vários fatores influenciam a escolha da modalidade de diálise, incluindo as características individuais e clínicas do paciente no início do tratamento, as preferências dos pacientes e mé-dicos e a localização geográfica 3,4,5 . Alguns estudos também têm enfocado a importância de fatores econômicos na escolha da modalidade tais como a forma de pagamento do tratamento e a disponibilidade de recursos 6 .…”