Waard, M. de (Marjolein) (2016) Paediatric chronic kidney dialysis in Brazil The impact of age on the incidence and prevalence of end-stage renal disease in Brazilian children and adolescents. thesis, Medicine.
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Abstract
Introduction Chronic kidney disease (CKD) has become increasingly prevalent in children worldwide in the last few decades. Severe cases of CKD eventually progress into end-stage renal disease (ESRD), which means the necessity of renal replacement therapy (RRT). CKD and especially ESRD is a greatly impairing disease in children. The foresight of lifelong treatment and medication has a big impact on the psychological and physical quality of life. However, ESRD in children is less frequent than in adults. In Brazil the prevalence is 20.0 cases per million age-related population (pmarp) and the incidence is 6.0 pmarp in patients under twenty years of age. RRT will generally be initiated in children when the final stage (G5, according to the KDOQI guidelines) of CKD is reached. Disparities in treatment worldwide occur due to ethnic, socio-economic and developmental reasons. These factors vary greatly within Brazil and this may have an impact on the incidence and prevalence rates of ESRD in children in Brazil. Furthermore, age may have an influence on these rates. Objective The main aim of this study was to investigate age related differences in incidence and prevalence rates of chronic kidney dialysis treatment in children in Brazil. Furthermore we aimed to test if geographical region has any influence on the effect of age on incidence and prevalence rates. Methods The database from a previous study was explored. A questionnaire was used for the collection of data in a representative sample of 239 dialysis centers spread across Brazil. Brazil was divided into four macro-regions: North-Midwest, Northeast, Southeast and South. The target population consisted of all patients under twenty years of age on chronic dialysis at any moment in 2012. A total of 643 patients were included. In all statistical analyses a technique for sample expansion was used. Calculation and estimation of the incidence and prevalence rates with age as a continuous variable was performed for the total sample population. In a second analysis the sample population was divided into 16 different subgroups, labelled by age group and macro-region. In these subgroups incidence and prevalence rates were calculated. The generated incidence and prevalence rates were used for linear regression, correlation and interaction analyses, all considering the different macro-regions in Brazil. Results The continuous analysis of incidence and prevalence according to age showed a sudden increase after the age of 11 years, with a peak around the age of 16 years. The numeric analysis over the different age groups also showed that, as well the incidence, as the prevalence rates increase from the third age group (10 - <20 y/a) in all regions. Analysis between age and incidence and age and prevalence showed the existence of a correlation between the factors: with the increase of age, both the incidence and prevalence increase. The overall correlation age-incidence was r=0.62 and the correlation age-prevalence was r=0.76 in Brazil. Moreover, linear regression analyses showed that the incidence increases around 0.5 cases pmarp and the prevalence increases from 1.5 to 2.0 cases pmarp per year of age in Brazil and the four macro-regions. Interaction analysis showed a significant interaction between the North-Midwest and the South region on the incidence rates (p=0.049). Conclusion Age has a positive effect on the incidence and prevalence rates of paediatric patients undergoing chronic dialysis in Brazil. There is a plausible influence of geographical region on the effect of age on the incidence and prevalence, with lower rates of younger children in the North-Midwest region when compared to the South of the country.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Son - Prof. Dr. W.J. Van Nephrologist, UMC Groningen |
| Supervisor name: | Local supervisors: and Sesso, Prof. Dr. R.C. MD PhD - Nephrologist and Koch Nogueira, Prof. Dr. P.C. MD PhD - Paediatric and nephrologist, UNIFESP and Daily supervisor: and Konstantyner, Dr. T. MD PhD - Paediatrician |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1007 |
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