Outcomes of a Peritoneal Dialysis Program in Remote Communities within Colombia

Abstract

♦ Background and Objective: Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. ♦ Patients and Methods: The present study was a multicenter cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. ♦ Results: A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 -US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. ♦ Conclusions: With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia. Perit Dial Int

Economic Impact of a Peritoneal Dialysis Continuous Quality Improvement Program in Colombia

“…As noted, Colombia is a country with a relatively high PD utilization rate, the reasons for which have been previously described by Sanabria and others (17). In Colombia there is a network of renal treatment facilities called Renal Therapy Services (RTS) that have implemented a PD CQI program.…”

Aspectos epidemiológicos de pacientes com doença renal crônica em programa de diálise peritoneal: levantamento de 22 anos

“…Uma possível explicação a este dado é o aumento de mulheres em DP, podendo estar relacionado à feminização do envelhecimento (IBGE, 2013 Outro estudo com dados diferentes deste foi relatado por Sanabria et al, no qual a maioria dos pacientes apresentou óbito como desfecho mais comum (40,8%) (SANABRIA et al, 2015).…”

“…Em decorrência da busca literária, encontrou-se o estudo de Bevilacqua et al (1995) (2012) encontrou 40,9% dos pacientes com DM, frequência bastante superior aos achados deste estudo. Alguns estudos internacionais fortalecem esse dado, nos quais a maior porcentagem de causa de DRC é DM (DUONG et al, 2012;SANABRIA et al, 2015;YANG et al, 2013). No estudo nacional BRAZPD, 37% da população nacional que realiza DP apresenta DM (DE MORAES et al, 2014).…”

“…Já em comparação com estudos internacionais, estes dados foram corroborados em relação a descrição dos resultados dos estudos. (CHUANG et al, 2016;RAJAEEFARD et al, 2016;SANABRIA et al, 2015).…”

“…Esse dado é semelhante em vários estudos (BAE et al, 2015;GONÇALVES et al, 2013;OLIVEIRA et al, 2014;SANABRIA et al, 2015). Ao analisarmos a média Ainda Bevilacqua et al (1995) descreveu dados referentes ao tempo de acompanhamento inferior ao deste estudo como também, Oliveira et al (2016) no qual o tempo de acompanhamento foi de 1,5 anos de seguimento.…”