Acceptance for chronic dialysis treatment: Insufficient and unequal

Background. Evidence suggests that a number of end-stage renal disease (ESRD) patients die without receiving dialysis. We investigated and compared ESRD patients who died without receiving treatment and those who were accepted for dialysis.Methods. All patients starting chronic dialysis in 1991 in the city of Sao Paulo and prospectively registered in the Health Secretariat files were studied. From death certificates we obtained data from all patients dying with an underlying cause associated with chronic renal failure. Medical records from a sample of patients who died without receiving dialysis were reviewed.Results. Of 2127 patients, 1582 (74.4%) received dialysis and 545 (25.6%) did not. The best chance of being dialysed occurred in the 20-29 age group. The age groups with the least chance of receiving dialysis were 0-9 years and over 79 years old. The odds ratio (95% Cl) of not receiving dialysis was 12.42 (6.63-23.82) times greater for patients over 60 years old compared to those aged 20-29 years. Patients with renal failure due to congenital diseases, chronic pyelonephritis, unknown cause, and hypertension were less likely to receive dialysis than those with glomerulonephritis or diabetes.Conclusions. Our results suggest that many ESRD patients die without receiving dialysis. Age and cause of renal disease influence the chance of being accepted for treatment. Restrictions of treatment need to be corrected to guarantee that maintenance dialysis will be accessible to ESRD patients.UNIV FED SAO PAULO,HLTH INFORMAT CTR,ESCOLA PAULISTA MED,BR-04023062 SAO PAULO,BRAZILUNIV FED SAO PAULO,CLIN EPIDEMIOL UNIT,ESCOLA PAULISTA MED,BR-04023062 SAO PAULO,BRAZILAIM PREFEITURA SAO PAULO,PRO,SAO PAULO,BRAZILUNIV FED SAO PAULO,HLTH INFORMAT CTR,ESCOLA PAULISTA MED,BR-04023062 SAO PAULO,BRAZILUNIV FED SAO PAULO,CLIN EPIDEMIOL UNIT,ESCOLA PAULISTA MED,BR-04023062 SAO PAULO,BRAZILWeb of Scienc