ABSTRACT
BACKGROUND: Structured pre-dialysis care is associated with an increase in peritoneal dialysis (PD) utilization, but not with peritonitis risk, technical and patient survival. This study aimed at analyzing the impact of pre-dialysis care on these outcomes. METHODS: All incident patients starting PD between 2004 and 2011 in a Brazilian prospective cohort were included in this analysis. Patients were divided into 2 groups: early pre-dialysis care (90 days of follow-up by a nephrology team); and late pre-dialysis care (absent or less than 90 days follow-up). The socio-demographic, clinical and biochemical characteristics between the 2 groups were compared. Risk factors for the time to the first peritonitis episode, technique failure and mortality based on Cox proportional hazards models. RESULTS: Four thousand one hundred seven patients were included. Patients with early pre-dialysis care presented differences in gender (female - 47.0 vs. 51.1%, p = 0.01); race (white - 63.8 vs. 71.7%, p < 0.01); education (<4 years - 61.9 vs. 71.0%, p < 0.01), respectively, compared to late care. Patients with early pre-dialysis care presented a higher prevalence of comorbidities, lower levels of creatinine, phosphorus, and glucose with a significantly better control of hemoglobin and potassium serum levels. There was no impact of pre-dialysis care on peritonitis rates (hazard ratio (HR) 0.88; 95% CI 0.77-1.01) and technique survival (HR 1.12; 95% CI 0.92-1.36). Patient survival (HR 1.20; 95% CI 1.03-1.41) was better in the early pre-dialysis care group. CONCLUSION: Earlier pre-dialysis care was associated with improved patient survival, but did not influence time to the first peritonitis nor technique survival in this national PD cohort.
Subject(s)
Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Nephrology/methods , Peritoneal Dialysis , Peritonitis/epidemiology , Adult , Age Factors , Aged , Body Mass Index , Brazil/epidemiology , Comorbidity , Diabetes Mellitus/epidemiology , Educational Status , Female , Hemoglobins/metabolism , Humans , Hypertension/epidemiology , Kidney Failure, Chronic/mortality , Male , Middle Aged , Peripheral Arterial Disease/epidemiology , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Potassium/blood , Prospective Studies , Survival Rate , Time FactorsABSTRACT
The establishment of a Nursing Minimum Data Set (NMDS) can facilitate the use of health information systems. The adoption of these sets and represent them based on archetypes are a way of developing and support health systems. The objective of this paper is to describe the definition of a minimum data set for nursing in endometriosis represent with archetypes. The study was divided into two steps: Defining the Nursing Minimum Data Set to endometriosis, and Development archetypes related to the NMDS. The nursing data set to endometriosis was represented in the form of archetype, using the whole perception of the evaluation item, organs and senses. This form of representation is an important tool for semantic interoperability and knowledge representation for health information systems.
