Análisis de sobrevida en pacientes incidentes de hemodiálisis en Chile, 2013-2019

Background: Renal replacement therapies, especially hemodialysis (HD) in end-stage kidney disease, avoid an inevitable death caused by the disease. However, in elderly patients with multiple comorbidities, this therapy could derive in a comparable survival than conservative management. Considering that HD represents a high cost for the health system, it is worth analyzing the effects of HD on survival. Aim: To analyze the survival and mortality of all national health security system's patients (FONASA) admitted to HD in Chile from 2013 to 2019. Material and Methods: We requested to the Ministry of Health information about all patients affiliated to the public health insurance system that started dialysis between 2013 and 2019. We evaluated the influence of age when starting HD, sex, presence of hypertension, presence of diabetes mellitus (DM), the region of residence, and year of admission on mortality. Results: A total of 24,113 patients aged 61 ± 15 years (45% women) were analyzed. Forty five percent of patients were aged > 65 years. After 5 years of follow-up, the median survival in this age group was 36.1 months. Among patients who started HD at age > 85 years, the median survival was 14.8 months. Diabetic patients had a median survival of 52.3 months. Advanced age and DM were associated with higher annual mortality. Also, the region of residence and year of admission were associated with higher mortality at 3 and 12 months. Conclusions: The median survival of patients on HD is dependent on age and the presence of comorbidities, among other factors. We performed an analysis to determine if starting HD in older patients with comorbidities has a real benefit over conservative management in terms of survival.

Lugar de muerte en Chile: un estudio descriptivo de serie temporal entre 1990-2014 / Place of Death in Chile: a descriptive study of a time series from 1990 to 2014

Background: With the aim to inform end of life public policies, the place of death in Chile, its trends and associated factors were analysed. Materials and Methods: A cross sectional using publically available death database from 1990 to 2014 was conducted. The proportion of hospital deaths was selected as the main outcome. A logistic regression was used to assess the association between place of death, age, and main diagnosis at death. Also, a Prais-Winsten regression and a Chi2 test were used to assess a time series and regional analysis, respectively. Results: 2,063,615 deaths were analysed. Overall, deaths 898,871 (43.6%) occurred at hospital. Those who died over 85 years (OR 2,52 IC95% 2.49-2.55) and those who died from cancer (OR 2.43 IC95% 2.42-2.45) had higher risk for dying outside de hospital. For the general population and those who die form cancer, there is no evidence for an increase or decrease trend in the proportion of hospital deaths over time (p = 0,75 and p = 0.68, respectively). However, there is an increase of the proportion of hospital deaths in those who died over 85 years (p < 0.001,27% in 1990 to 32% in 2014). Also, there are geographic differences between country regions (p < 0.001) (Eg. Magallanes 52.9%). Conclusions: The proportion of hospital deaths has been stable over time in the general population and has increased in those over 85 years.