Global costs attributed to chronic kidney disease: a systematic review

SUMMARY The aim of this study is to discuss the global costs attributed to chronic kidney disease (CKD) and its impact on healthcare systems of developing countries, such as Brazil. This is a systematic review based on data from PubMed/Medline, using the key words "costs" and "chronic kidney disease", in January 2017. The search was also done in other databases, such as Scielo and Google Scholar, aiming to identify regional studies related to this subject, published in journal not indexed in PubMed. Only papers published from 2012 on were included. Studies on CKD costs and treatment modalities were prioritized. The search resulted in 392 articles, from which 291 were excluded because they were related to other aspects of CKD. From the 101 remaining articles, we have excluded the reviews, comments and study protocols. A total of 37 articles were included, all focusing on global costs related to CKD. Despite methods and analysis were diverse, the results of these studies were unanimous in alerting for the impact (financial and social) of CKD on health systems (public and private) and also on family and society. To massively invest in prevention and measures to slow CKD progression into its end-stages and, then, avoid the requirement for dialysis and transplant, can represent a huge, and not yet calculated, economy for patients and health systems all over the world.

RESUMO O objetivo deste estudo é discutir os custos financeiros mundiais atribuídos à doença renal crónica (DRC) e suas repercussões sobre os sistemas de saúde em países em desenvolvimento, como o Brasil. Trata-se de uma revisão sistemática realizada na base de dados do PubMed/Medline, utilizando os termos em inglês "costs" e "chronic kidney disease", em janeiro de 2017. A busca foi ampliada a outros bancos, como o Scielo e o Google Acadêmico, com o objetivo de identificar estudos locais relacionados ao assunto, publicados em revistas não indexadas no PubMed. Foram incluídos apenas artigos publicados a partir de 2012. Priorizaram-se estudos que abordavam os custos da DRC e das modalidades de tratamento. A busca resultou em 392 artigos, dos quais foram excluídos 291 por fugirem da temática principal desta revisão. Dos 101 restantes, foram excluídos revisões, comentários e protocolos. Foram incluídos 37 artigos cujo foco eram os custos globais relacionados à DRC. Apesar de os métodos e análises serem diversos, os resultados dos estudos são unânimes em alertar sobre o forte impacto, financeiro e social, da DRC que atinge os sistemas de saúde, públicos e privados, portadores da doença, familiares e a sociedade. Investir maciçamente em prevenção e nas medidas para retardar a progressão da DRC para os estágios finais e, consequentemente, evitar a necessidade de diálise e transplante, podem representar uma enorme, e ainda não calculada, economia para pacientes e sistemas de saúde do mundo todo.

Increasing violent deaths and organ transplantation in Brazil: is there a parallel? / Aumento do número de mortes violentas e transplante de órgãos no Brasil: há um paralelo?

Abstract Mortality from violent causes has significantly increased in Brazil, as well as the number of deceased-donor organ transplantation. Although the increase in the number of transplants correlates with higher organ availability, through the increase in potential donors, this is not the unique aspect to be considered. The effective and articulated action of transplantation network seems to be decisive to this outcome.

Resumo A mortalidade por causas violentas tem aumentado de modo significativo no Brasil, bem como o número de transplantes de órgãos com doador falecido. Apesar de o aumento do número de transplantes correlacionar-se com o aumento na disponibilidade de órgãos, por meio do aumento no número de potenciais doadores, este não é o único aspecto a ser considerado. A ação efetiva e articulada das centrais de transplante parece ser decisiva para estes resultados.

Community-acquired urinary tract bacterial infections and drug resistance among patients followed at a reference center in Fortaleza, Ceará, Brazil

Background: The aim of this study was to assess the antimicrobial resistance pattern of the most frequent pathogens responsible for community-acquired urinary tract infection (UTI). Methods: This is a retrospective, descriptive epidemiological survey involving all urine samples submitted for culture and antimicrobial susceptibility testing from patients with clinical diagnosis of UTI followed at the outpatient clinic of the Núcleo de Atenção Médica Integrada, University of Fortaleza, Brazil. The study period was from September 2012 to July 2013. Urine cultures were processed with clean-catch midstream urine samples in the local laboratory employing standard methods. A questionnaire was used to collect patient demographic data and the results of the bacterial identification and susceptibility testing. The data were analyzed by SPSS software. Results: A total of 514 urine samples were analyzed. Most patients were females (78.6%). Patients' mean age was 39 years old. Bacterial growth was observed in 16.5% of the samples. This rate was lower in women (13.6%) than in men (27.3%). The most prevalent pathogen was Escherichia coli (57.6%), followed by Klebsiella sp. (35.3%) and Proteus sp. (4.7%). E. coli showed a high frequency of resistance to ampicillin (88.2%) and sulfamethoxazole/trimethoprim (77.1%), as well as significant resistance to ciprofloxacin (38.9%) and norfloxacin (39.4%). Isolates from elderly patients (>60 years) had higher resistance to all tested antibiotics. Conclusions: There is a trend toward increasing bacterial resistance among the main UTI pathogens. Resistance to sulfamethoxazole/trimethoprim follows a worldwide increase rate tendency and it should be avoided as a first-line empirical treatment for UTIs. A significant resistance to quinolones was also observed.