Assuntos
Hispânico ou Latino/estatística & dados numéricos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/cirurgia , Transplante de Rim , Imigrantes Indocumentados/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Equador/etnologia , Feminino , Guatemala/etnologia , Humanos , Falência Renal Crônica/etnologia , Masculino , México/etnologia , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
INTRODUCTION: Diabetes is the most common cause of chronic kidney disease, with a high economic impact on health systems. OBJECTIVE: To estimate the cost of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) attributable to diabetes, stratified by sex, race/skin color, and age, from the perspective of the Brazilian public health system between 2010 and 2016. METHODS: Population attributable risk (PAR) was calculated from the Brazilian prevalence of diabetes and the relative risk (or odds ratio) of persons with diabetes developing CKD and ESKD as compared to non-diabetic subjects. The variables of interest were sex, race/skin color, and age. A top-down approach was used to measure the direct costs of the disease reimbursed by the Brazilian Ministry of Health, using data from outpatient and inpatient records. RESULTS: The cost of CKD and ESKD attributable to diabetes in the period 2010-2016 was US$1.2 billion (US$180 million per year) and trending upward. Female sex, age 65-75, and black race/skin color contributed substantially to the costs of CKD and ESKD (US$475 million, US$63 million, and US$25 million respectively). The clinical procedures accounting for the greatest share of disease-attributable costs are hemodialysis and peritoneal dialysis. CONCLUSION: Diabetes accounted for 22% of the costs of CKD and ESKD. Female sex, age 65-75 years, and black race/skin color were the variables which contributed most to disease-related expenditure. The economic burden of CKD may increase gradually in the coming years, with serious implications for the financial sustainability of the Brazilian public health system.
Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus/epidemiologia , Falência Renal Crônica/economia , Diálise Renal/economia , Insuficiência Renal Crônica/economia , Fatores Etários , Idoso , Brasil/epidemiologia , Diabetes Mellitus/etnologia , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Falência Renal Crônica/etnologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Masculino , Prontuários Médicos , Razão de Chances , Diálise Peritoneal/economia , Insuficiência Renal Crônica/etnologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapiaRESUMO
BACKGROUND: Racial discrimination may play a significant role in higher incidence and poorer prognosis of chronic kidney disease among Black individuals. This study set out to investigate the association between racial discrimination and renal function and to estimate the contribution of racial discrimination to existing racial disparities in renal function. METHODS: A cross-sectional analysis using baseline data (2008-2010) of 14 355 participants (35-74 years) in the Brazilian Longitudinal Study of Adult Health cohort study. Renal function was estimated based on estimated glomerular filtration rates (eGFR) obtained by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Racial discrimination was assessed using a modified version of the Lifetime Major Events Scale ; race/colour was self-reported. Covariates included were age, sex, level of education and selected health-related factors. RESULTS: Racial discrimination was reported by 31.6%, 6.3% and 0.8% of Black, Brown and White individuals, respectively. The older the age, the lower the prevalence of racial discrimination among Blacks. Racial discrimination was independently associated with lower mean eGFR (ß=-2.38; 95% CI -3.50 to -1.25); however, associations were limited to individuals aged under 55 years. In this age group, eGFR differences between Black and White individuals were reduced by 31% when exposure to racial discrimination was accounted for. CONCLUSION: Blacks are approximately 40 times more likely to report racial discrimination than Whites. Racial discrimination was associated with lower mean eGFR and explained a significant portion of eGFR differences between Black and White individuals aged under 55 years. Exposure to experiences of racial discrimination should be accounted for in studies investigating racial disparities in renal function.
Assuntos
Falência Renal Crônica/etnologia , Racismo , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Falência Renal Crônica/etnologia , Falência Renal Crônica/terapia , Diálise Renal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia/etnologia , Feminino , Guiana/etnologia , Humanos , Incidência , Jamaica/etnologia , Falência Renal Crônica/epidemiologia , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Somália/etnologia , Sudão/etnologia , Trinidad e Tobago/etnologia , Adulto JovemRESUMO
BACKGROUND: Despite effective antiviral treatment, hundreds of kidneys from deceased donors with hepatitis C virus (HCV) are discarded annually. Little is known about the determinants of willingness to accept HCV-infected kidneys among HCV-negative patients. METHODS: At 2 centers, 189 patients undergoing initial or reevaluation for transplant made 12 hypothetical decisions about accepting HCV-infected kidneys in which we systematically varied expected HCV cure rate, allograft quality, and wait time for an uninfected kidney. RESULTS: Only 29% of the participants would accept an HCV-infected kidney under all scenarios, whereas 53% accepted some offers and rejected others, and 18% rejected all HCV-infected kidneys. Higher cure rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.33-5.24 for 95% vs 75% probability of HCV cure), younger donor (OR, 2.34; 95% CI, 1.91-2.88 for a 20-year-old vs a 60-year-old hypertensive donor), and longer wait for an uninfected kidney (OR, 1.43; 95% CI, 1.22-1.67 for 5 years vs 2 years) were associated with greater willingness to accept an HCV-infected kidney. Black race modified the effect of HCV cure rate, such that willingness to accept a kidney increased less for blacks versus whites as the cure rate improved. Patients older than 60 years and prior kidney recipients showed greater willingness to accept an HCV-infected organ. CONCLUSIONS: Most patients will consider an HCV-infected kidney in some situations. Future trials using HCV-infected kidneys may enhance enrollment by targeting older patients and prior transplant recipients, but centers should anticipate that black patients' acceptance of HCV-infected kidneys will be reduced compared with white patients.
Assuntos
Negro ou Afro-Americano/psicologia , Seleção do Doador , Hepatite C , Falência Renal Crônica/cirurgia , Transplante de Rim/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Entrevistas como Assunto , Falência Renal Crônica/etnologia , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Risco , Estados UnidosRESUMO
Chronic kidney disease is a non-communicable disease that is now well recognized as a major source of premature morbidity and mortality. In general, racial/ethnic minorities in the United States are more likely than non-minority groups to develop end-stage renal disease (ESRD), but paradoxically most have a lower mortality risk. Unlike most minorities, dialysis patients in Puerto Rico have a mortality risk nearly 50% higher than the national average. Multiple factors such as medical conditions, socioeconomic, environmental, and health system factors can influence health outcomes for patients with ESRD. We describe one potential health system factor that may contribute to this finding, a unique interpretation and implementation of the ESRD Medicare Secondary Payer provision in the Commonwealth of Puerto Rico. We conducted a search of regulatory documents and key stakeholder interviews to help envision the potential implications of these differences for dialysis facilities, health care providers, and patients with ESRD.
Assuntos
Disparidades em Assistência à Saúde , Falência Renal Crônica/terapia , Medicare/economia , Mecanismo de Reembolso , Diálise Renal/economia , Etnicidade/estatística & dados numéricos , Política de Saúde , Disparidades nos Níveis de Saúde , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/etnologia , Falência Renal Crônica/mortalidade , Grupos Minoritários/estatística & dados numéricos , Porto Rico/epidemiologia , Diálise Renal/estatística & dados numéricos , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE:: to propose a family care model for patients with chronic kidney disease in peritoneal dialysis based on evidence indicated by family members. METHOD:: this was a qualitative descriptive study that used the Convergent Care Research method. It was conducted at a state hospital in Rio de Janeiro, including techniques for recording individual interviews and consisted of a group of 19 study participants. Data were analyzed according to the stages proposed by the method, generating a category that used a cultural question as the basis for patient care resulting in a proposal for home-based family care. RESULTS:: the patient care model proposed includes dialogue and reflection in sharing the knowledge of "professional" and "popular" systems, aiming to improve the patient's quality of life. CONCLUSION:: family members were able to promote care based on cultural preservation, accommodation and repatterning, as proposed by Leininger's Sunrise Model.
Assuntos
Família , Hemodiálise no Domicílio , Falência Renal Crônica/terapia , Papel do Profissional de Enfermagem , Diálise Peritoneal , Brasil , Enfermagem em Saúde Comunitária , Características Culturais , Feminino , Humanos , Entrevistas como Assunto , Falência Renal Crônica/etnologia , Falência Renal Crônica/enfermagem , Masculino , Inquéritos e QuestionáriosRESUMO
RESUMO Objetivo: propor um modelo de cuidado familiar ao cliente renal crônico em tratamento com a Diálise Peritoneal a partir das evidências apontadas pelos familiares. Método: estudo descritivo com abordagem qualitativa, tendo como método a Pesquisa Convergente Assistencial. O cenário foi um hospital estadual do Rio de Janeiro, onde foram realizadas as técnicas de entrevista individual gravada e de um grupo de encontro com 19 participantes da pesquisa. Os dados foram analisados de acordo com as etapas propostas pelo método, emergindo uma categoria sobre a questão cultural como base para o cuidado: uma proposta de cuidado familiar no domicílio. Resultados: o modelo de cuidado proposto contempla o diálogo e a reflexão, no sentido de compartilhar os saberes dos sistemas "profissional" e "popular", visando à melhoria da qualidade de vida dos clientes. Conclusão: os familiares conseguiram realizar a preservação, acomodação e repadronização cultural do cuidado propostas pelo modelo Sunrise de Leininger.
RESUMEN Objetivo: proponer un modelo de cuidado familiar al paciente renal crónico en tratamiento con Diálisis Peritoneal partiendo de las evidencias informadas por familiares. Método: estudio descriptivo, con abordaje cualitativo, usando como método la Investigación Convergente Asistencial, realizado en hospital estatal de Rio de Janeiro, donde fueron realizadas las técnicas de entrevista individual grabada y un grupo de encuentro con 19 participantes de la investigación. Datos analizados según las etapas propuestas por el método, emergiendo una categoría sobre la cuestión cultural como base para el cuidado: una propuesta de cuidado familiar domiciliario. Resultados: el modelo de cuidado propuesto contempla el diálogo y la reflexión, apuntando a compartir los saberes de los sistemas "profesional" y "popular", con objetivo de mejorar la calidad de vida del paciente. Conclusión: los familiares consiguieron realizar la preservación, acomodación y reestandarización cultural del cuidado propuestas por el modelo Sunrise de Leininger.
ABSTRACT Objective: to propose a family care model for patients with chronic kidney disease in peritoneal dialysis based on evidence indicated by family members. Method: this was a qualitative descriptive study that used the Convergent Care Research method. It was conducted at a state hospital in Rio de Janeiro, including techniques for recording individual interviews and consisted of a group of 19 study participants. Data were analyzed according to the stages proposed by the method, generating a category that used a cultural question as the basis for patient care resulting in a proposal for home-based family care. Results: the patient care model proposed includes dialogue and reflection in sharing the knowledge of "professional" and "popular" systems, aiming to improve the patient's quality of life. Conclusion: family members were able to promote care based on cultural preservation, accommodation and repatterning, as proposed by Leininger's Sunrise Model.
Assuntos
Humanos , Masculino , Feminino , Família , Hemodiálise no Domicílio , Falência Renal Crônica/terapia , Papel do Profissional de Enfermagem , Diálise Peritoneal , Brasil , Enfermagem em Saúde Comunitária , Características Culturais , Entrevistas como Assunto , Falência Renal Crônica/etnologia , Falência Renal Crônica/enfermagem , Inquéritos e QuestionáriosRESUMO
IMPORTANCE: Diabetic kidney disease is the leading cause of chronic and end-stage kidney disease in the United States and worldwide. Changes in demographics and treatments may affect the prevalence and clinical manifestations of diabetic kidney disease. OBJECTIVE: To characterize the clinical manifestations of kidney disease among US adults with diabetes over time. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional studies of adults aged 20 years or older with diabetes mellitus participating in National Health and Nutrition Examination Surveys from 1988 through 2014. EXPOSURES: Diabetes was defined as hemoglobin A1c greater than 6.5% or use of glucose-lowering medications. MAIN OUTCOMES AND MEASURES: Albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g), macroalbuminuria (urine albumin-to-creatinine ratio ≥300 mg/g), reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2), and severely reduced eGFR (<30 mL/min/1.73 m2), incorporating data on biological variability to estimate the prevalence of persistent abnormalities. RESULTS: There were 6251 adults with diabetes included (1431 from 1988-1994, 1443 from 1999-2004, 1280 from 2005-2008, and 2097 from 2009-2014). The prevalence of any diabetic kidney disease, defined as persistent albuminuria, persistent reduced eGFR, or both, did not significantly change over time from 28.4% (95% CI, 23.8%-32.9%) in 1988-1994 to 26.2% (95% CI, 22.6%-29.9%) in 2009-2014 (prevalence ratio, 0.95 [95% CI, 0.86-1.06] adjusting for age, sex, and race/ethnicity; P = .39 for trend). However, the prevalence of albuminuria decreased progressively over time from 20.8% (95% CI, 16.3%-25.3%) in 1988-1994 to 15.9% (95% CI, 12.7%-19.0%) in 2009-2014 (adjusted prevalence ratio, 0.76 [95% CI, 0.65-0.89]; P < .001 for trend). In contrast, the prevalence of reduced eGFR increased from 9.2% (95% CI, 6.2%-12.2%) in 1988-1994 to 14.1% (95% CI, 11.3%-17.0%) in 2009-2014 (adjusted prevalence ratio, 1.61 [95% CI, 1.33-1.95] comparing 2009-2014 with 1988-1994; P < .001 for trend), with a similar pattern for severely reduced eGFR (adjusted prevalence ratio, 2.86 [95% CI, 1.38-5.91]; P = .004 for trend). Significant heterogeneity in the temporal trend for albuminuria was noted by age (P = .049 for interaction) and race/ethnicity (P = .007 for interaction), with a decreasing prevalence of albuminuria observed only among adults younger than 65 years and non-Hispanic whites, whereas the prevalence of reduced GFR increased without significant differences by age or race/ethnicity. In 2009-2014, approximately 8.2 million adults with diabetes (95% CI, 6.5-9.9 million adults) had albuminuria, reduced eGFR, or both. CONCLUSIONS AND RELEVANCE: Among US adults with diabetes from 1988 to 2014, the overall prevalence of diabetic kidney disease did not change significantly, whereas the prevalence of albuminuria declined and the prevalence of reduced eGFR increased.
Assuntos
Albuminúria/epidemiologia , Nefropatias Diabéticas/epidemiologia , Falência Renal Crônica/epidemiologia , Adulto , Idoso , Albuminúria/diagnóstico , Albuminúria/etnologia , População Negra/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Nefropatias Diabéticas/etnologia , Feminino , Taxa de Filtração Glomerular , Hemoglobinas Glicadas/análise , Hispânico ou Latino/estatística & dados numéricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipoglicemiantes/uso terapêutico , Falência Renal Crônica/etnologia , Masculino , México/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Fatores de Tempo , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Patients with end stage renal disease (ESRD) experience a high symptom burden and poor quality of life as part of their advanced illness. Latinos experience a higher prevalence of ESRD compared to non-Latino whites; however, they are underrepresented in existing ESRD literature. We conducted a systematic review of qualitative studies that include Latino patients with ESRD and their caregivers in the United States. Of 694 citations published through August 2014, six met inclusion criteria. Four major themes emerged: 1) Losses, 2) Heightened awareness of death, 3) Barriers to quality communication and care, and 4) Mediating Latino traditions and values. A thematic schema was developed.