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Previous issue date: 2010-11-24 / Introdução: Hemodialise convencional (HD) e dialise peritoneal ambulatorial (DP) sao modalidades de terapia renal substitutiva (TRS). HD predomina em todo o mundo. A literatura sobre qualidade de vida (QV) e custos desses pacientes e robusta, mas sem consenso quanto a diferencas entre elas. Estudos prospectivos e comparativos sao escassos. Objetivo: Descrever e avaliar prospectivamente, a qualidade de vida, os recursos consumidos e os custos totais ao nivel do paciente, comparando-se as modalidades HD e DP. Metodologia: De abril de 2007 a fevereiro de 2009, foram avaliados 249 pacientes em HD e 228 em DP. Foram incluidos pacientes .18 anos, estaveis quanto ao tratamento dialitico e sem co-morbidades que competissem em gravidade ou consumo de recursos. Os dados foram coletados em tres tempos (inicio, 6m e 12m), atraves de questionarios padronizados (dados clinicos e recursos consumidos), SF-12 e KDQoL, nos tres tempos do seguimento. A fonte dos custos foi atraves da Tabela do SUS, dos itens da portaria 2042/96 e, para dialise de manutencao, foi adicionada a media dos pacotes reembolsados pela Saude Suplementar. A perspectiva foi a sociedade. Analise estatistica: Foram realizadas medidas de tendencia central e dispersao. Comparacoes de QV foram feitas pelo Teste T de Student. A proporcao de mudanca dos escores de QV foi feita pelo teste de Benjamin-Hochberg. Modelos de regressao foram desenvolvidos para avaliar o impacto da modalidade nos seguintes aspectos: (1) na QV, durante os tres tempos; (2) na mudanca de QV ao longo do seguimento e (3) nos custos medios totais por paciente por ano. Os modelos foram ajustados por idade, sexo, fonte pagadora, comorbidades, taxa de fosforo e taxa de hemoglobina. Resultados: 189 de 249 (76%) pacientes em HD e 161 de 228 (71%) pacientes de DP completaram o seguimento. A media de idade foi 55.8 e 59.8 anos (p=0.001) para HD e DP e 59% vs 68%, respectivamente, tinham diagnostico de diabetes (p=0.03). Os sumarios do SF-12 nao mostraram diferencas estatisticamente significantes entre os grupos. Dos dominios do KDQoL, notou-se que satisfacao do paciente (p= 0.002, 0.005, 0.005, respectivamente), encorajamento e suporte (p=0.003, 0.017, 0.029) e carga da doenca (p=0.003, 0.017, 0.057) foram persistentemente favoraveis ao grupo DP nos tres tempos. O grupo HD foi o que mais variou ao longo do tempo, com piora [estado cognitivo (p=0.045)] ou melhora [encorajamento (p=0.041) e estado de saude (p=0.012)]. Custo medio total por paciente por ano foi de US{dollar} 28,570 para o grupo HD e de US{dollar}27,158 para o grupo DP, distribuidos entre custo direto medico-hospitalar (82.3% e 86.5%, para HD e DP, respectivamente); custo direto nao medico-hospitalar (5.3%, para HD e 3.7%, para DP) e custo indireto (12.4% e 9.8% para HD e DP, respectivamente). Os modelos de regressao linear multiplos mostraram que, em diferentes dominios, a DP influencia favoravelmente a QV. Nao houve dominio favoravel a HD. Alem disso, a modalidade DP favoreceu aos custos da DP (p=0.025). CONCLUSOES: Existem diferencas favoraveis para o grupo DP quanto em alguns dominios da QV. Essas diferencas foram clinicamente significantes. A diferenca entre os custos medios totais foi estatisticamente significantes. / Introduction: Conventional hemodialysis (HD) and ambulatory peritoneal dialysis (PD) are different types of Renal Replacement Therapy (RRT). HD predominates around the world. The literature on patient quality of life (QoL) and the cost to these patients is robust, but there is no clear consensus as to the differences between the two therapies. Prospective and comparative studies are scarce. Objective: Prospective assessment and description of the quality of life, resources used and total patient costs for both HD and PD. Methodology: Between April 2007 and February 2009, 249 patients on HD and 228 on PD were assessed. All patients were 18 years or over and on stable dialysis, with no co-morbidities to compete with severity or resources. The information was collected at three different moments (baseline at the start of the study, at 6 months and at 12 months) using standard questionnaires (clinical data and resources used), SF-12 and KDQoL (Kidney Disease Quality of Life) in all three follow-up moments. The source for costs was the SUS Table (SUS is the Brazilian Unified Healthcare System) for items listed in directive 2041/96, and for maintenance dialysis, we added the average cost of the packages reimbursed by supplemental healthcare systems. The perspective was society as a whole. Statistical analysis: We measured core trends and dispersions. Student.s T test was used to compare QoL. The percent change in QoL scores was assessed using the Benhamin-Hochberg test. Regression models were developed to assess the impact of modality on the following aspects: QoL in the three moments; (2) the change in QoL during follow-up and (3) on the average total cost per patient per year. The models were adjusted for age, gender, payor, comorbidity, phosphorous and hemoglobin. Results: 189 out of 249 (76%) of the HD patients and 161 out of 228 (71%) of the PD dialysis patients completed the follow-up period. The average age was 55.8 and 58.9 years (p=0.001) for HD and DP patients respectively. 59% and 68% had been diagnosed with diabetes (p=0.03). The SF-12 summaries showed no significant statistical differences between the two groups. In the KDQoL domains we noticed that patient satisfaction (p= 0.002, 0.005, 0.005, respectively), encouragement and support (p=0.003, 0.017, 0.029) and burden of disease (p=0.003, 0.017, 0.057) persistently favored the PD patients in all three moments. The HD group showed the largest variations over time, with worsening cognitive status (p=0.045), and improvement in encouragement (p=0.041), and health status (p=0.12). The average total cost per patient per year was US{dollar} 8.570 for HD patients and US{dollar} 27,158 for PD patients. Costs break down into medico-hospital (82.3% and 96% respectively for HD and PD patients respectively), non medico-hospital direct costs (5.3% for HD and 3.7% for PD patients), and indirect costs (12.4% and 9.8% respectively). The multiple linear regression models show that in numerous domains PD has a favorable influence on QoL. No domain favored HD. In addition, the PD modality favored PD costs (p=0.025). CONCLUSIONS: In some QoL domains differences favor the PD group. These differences are clinically significant. The difference in average total cost was statistically significant. / TEDE / BV UNIFESP: Teses e dissertações
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unifesp.br:11600/9580 |
| Date | 24 November 2010 |
| Creators | Abreu, Mirhelen Mendes de [UNIFESP] |
| Contributors | Universidade Federal de São Paulo (UNIFESP), Ferraz, Marcos Bosi [UNIFESP] |
| Publisher | Universidade Federal de São Paulo (UNIFESP) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | 150 p. |
| Source | reponame:Repositório Institucional da UNIFESP, instname:Universidade Federal de São Paulo, instacron:UNIFESP |
| Rights | info:eu-repo/semantics/openAccess |
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