Allocation of Initial Modality for Renal Replacement Therapy in Brazil

Background and objectives: the use of dialysis modalities for ESRD varies around the world. There is no consensus in literature regarding the most appropriate choice of dialysis method. the aim of this study was to analyze the initial modality for ESRD in Brazil and evaluate the factors determining patients' allocation to either hemodialysis (HD) or peritoneal dialysis (PD).Design, setting, participants, & measurements: A retrospective cohort study was performed using national administrative registries of all patients financed by the public system who began renal replacement therapy in 2000 in Brazil. Logistic regression analysis was used to investigate factors associated with the probability of receiving HD or PD at the start of treatment. Independent variables tested were age, sex, presence of diabetes, geographic region of residence, and health care supply indicators.Results: of 11,563 patients analyzed, 88% started on HD and 12% started on PD. Patients were more likely to be assigned to HD if they were male (odds ratio: 1.44; 95% confidence interval: 1.23 to 1.68) and nondiabetic (odds ratio: 0.71; 95% confidence interval: 0.60 to 0.84). With regard to age, the youngest and the elderly showed lower probability of being in HD. in addition, the state of residence at the start of treatment was very important to explain initial modality allocation.Conclusions: Our findings suggest that patient allocation in Brazil is not random. the probability of allocation to HD or PD is highly associated with individual attributes and supply variables. Clin J Am Soc Nephrol 5: 637-644, 2010. doi: 10.2215/CJN.04840709Brazilian Health MinistryBrazilian National Council for Scientific and Technological DevelopmentFoundation for Research Support of the State of Minas GeraisUniv Fed Minas Gerais, Fac Med, Dept Social & Prevent Med, BR-30130100 Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Dept Econ, Ctr Dev & Reg Planning, BR-30130100 Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Fac Pharm, Dept Social Pharm, BR-30130100 Belo Horizonte, MG, BrazilPompeu Fabra Univ, Dept Econ, Res Ctr Econ & Hlth, Barcelona, SpainUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Div Nephrol, São Paulo, BrazilWeb of Scienc