Pre-dialysis chronic kidney disease progression over 4 years in the context of the Public Health System in Brazil: is ethnicity a factor?

Autor: Luciana dos Santos Tirapani Dalamura, Lucas Fernandes Suassuna, João Eduardo Cascelli Schelb Scalla Pereira, Rosália Maria Nunes Henriques Huaira, Neimar da Silva Fernandes, Priscylla Aparecida Vieira Carmo, Natalia Maria da Silva Fernandes
Jazyk: English<br />Portuguese
Rok vydání: 2021
Předmět:
Zdroj: HU Revista, Vol 47 (2021)
Druh dokumentu: article
ISSN: 1982-8047
0103-3123
DOI: 10.34019/1982-8047.2021.v47.34181
Popis: Introduction: The prevalence of chronic kidney disease (CKD) significantly increased, and populations with high social vulnerability tend to have worse CKD progression. Objective: To evaluate the impact of ethnicity on the control of pre-dialytic CKD in a Brazilian Unified Health System interdisciplinary outpatient clinic. Material and Methods: Data of 1,992 CKD patients were retrospectively collected from August/2010 to December/2014. Patients referred by primary health care, >18 years, ≥ two consultations were included. Sociodemographic data were collected upon admission; clinical and laboratory data were obtained at each consultation. Patients were divided into groups according to skin colour (self-identified). A descriptive analysis was performed; variables were compared using ANOVA, chi-square or Mann-Whitney U tests. Variables associated with the delta of the estimated glomerular filtration rate (eGFR) were evaluated using linear regression, adjusting for confounding variables. Results: 25.1% were black, 34.4% brown, and 40.5% white. Approximately 51.2% had income ≤ two minimum wages, 84.8% had low level education, 14.0% were illiterate. Black patients were younger and had lower education level; they had higher systolic blood pressure, total cholesterol, high-density lipoproteins, intact parathyroid hormone; their haemoglobin and vitamin D were lower. The median annual eGFR loss was 0 (P25 −6.70, P75 +8.76), 36.5% had rapid eGFR loss (>5 ml/min/year). Only use of angiotensin-converting enzyme inhibitors and low proteinuria were determined as significant for the outcome (RR: 0.92, CI: 0.010–0.684, p=0.02; RR: 0.8, CI: 0.998-0.999, p=0.001). Conclusion: Ethnicity did not impact CKD progression, even though black patients presented clinical and sociodemographic characteristics associated with worse disease progression.
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