Silva Junior, Geraldo Bezerra da; Oliveira, Juliana Gomes Ramalho de; Oliveira, Marcel Rodrigo Barros de; Vieira, Luiza Jane Eyre de Souza; Dias, Eduardo Rocha

doi:10.1590/1806-9282.64.12.1108

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Original Article • Rev. Assoc. Med. Bras. 64 (12) • Dez 2018 • https://doi.org/10.1590/1806-9282.64.12.1108 copiar

Global costs attributed to chronic kidney disease: a systematic review

Autoria SCIMAGO INSTITUTIONS RANKINGS

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.

PALAVRAS-CHAVE:
Insuficiência renal crónica; Diálise; Transplante de rim; Custos de cuidados de saúde

Main Author	Year	Country	Study Model	Study Object	Primary Conclusion
Small (8)	2017	United States	Cross-sectional	Costs of CKD treatment	The costs of patients with CKD who do not go through dialysis are high and may be equal to or higher than those of cancer or CVA patients.
Damien (9)	2016	United States	Cross-sectional	Costs of CKD treatment	Therapeutic follow-up before and after the beginning of dialysis and the managing of comorbidities are potential sources of savings in CKD care.
Eriksson (10)	2016	Sweden	Cohort	Costs of CKD treatment	In comparison with the general population, the average yearly costs for CKD treatment are higher in all its modalities.
Anutrakulchai (11)	2016	Thailand	Cross-sectional	Clinical outcomes and treatment costs for CKD	The group of hospitalized CKD patients who presented the fewest benefits and highest mortality was composed of farmers, low-income, and unemployed individuals.
Silva (12)	2016	Brazil	Environmental	Socioeconomic and mortality aspects for patients with CKD	Men and the elderly presented the highest mortality. Associated with a high prevalence, kidney transplant (deceased donor) and HD presented the highest costs.
Turchetti (13)	2016	Italy	Cross-sectional	Social cost per CKD patient stages 4-5 pre-dialysis	The indirect and non-medical direct costs from CKD treatment were similar to the direct costs.
Kerr (14)	2016	England	Cross-sectional	Cause, site, and hospital costs related to the death of CKD patients	The primary causes for the death of CKD patients were not kidney related. Deaths at home are associated with a reduction of hospital costs.
Roggeri (15)	2016	Italy	Retrospective cohort	Costs of CKD treatment	CKD is associated with a high economic burden and the beginning of dialysis with an increase in direct costs with health care.
Mendu (!6)	2016	United States	Retrospective cohort	Rational clinical criteria for the diagnosis of CKD.	Some clinical criteria can guide the diagnosis of CKD and reduce its costs.
Silva (17)	2016	Brazil	Cost analysis/Literature review	Costs of CKD treatment	Kidney transplant stood out as the best alternative from a financial and clinical point of view, under the perspective of the Unified Health System (SUS).
Kulkarni (18)	2015	India	Cross-sectional	Costs of CKD treatment	The costs of HD in India are high when compared with the per capita income in the country.
Atapour (19)	2015	Iran	Cross-sectional	Costs of CKD treatment	PD presents a lower cost lower than HD.
Ferguson (20)	2015	Canada	Cost models	Operation costs for dialysis units	HD units in remote areas are more expensive, per patient, than hospital HD in urban areas.
Francis (21)	2015	Peru	Cross-sectional	CKD demographics	The high prevalence rates of CKD in Lima and Tumbes are compatible with high-income countries.
Takura (22)	2015	Japan	Cost-effectiveness analysis	Cost-effectiveness of CKD treatment.	Hemodiafiltration is a cost-effective therapy.
Wyld (23)	2015	Australia	Cohort	Costs of CKD treatment	CKD patients spend 85% more on health treatments and 50% more government subsidies than individuals with no CKD, and costs rise as the disease progresses.
Ozieh (24)	2015	United States	Cross-sectional	The costs for CKD treatment on DM patients	CKD significantly contributes to the treatment costs for individuals with DM.
Kent(25)	2015	England	Cohort	Costs of CKD treatment	RRT and vascular events are the leading causes of the rising costs in CKD treatment.
Brunelli (26)	2015	United States	Retrospective cohort	Costs for CKD treatment in individuals with autosomal dominant polycystic kidney disease.	The use and costs of health care for patients with autosomal dominant polycystic kidney disease and CKD in the terminal stage in dialysis are high.
Blanchette (27)	2015	United States	Cross-sectional	Costs for CKD treatment in individuals with autosomal dominant polycystic kidney disease.	Patients with autosomal dominant polycystic kidney disease presented higher rates of renal procedures, which can contribute to the rising costs of treatment.
Medway (28)	2015	Australia	Qualitative	Financial impact of CKD in children	For parents, the impossibility of keeping their jobs combined with medical and non-medical expenses where the primary factors with a financial impact.
Menezes (29)	2015	Brazil	Cross-sectional/retrospective cohort	Costs of CKD treatment	A considerable increase in the number of HD sessions and their cost was found, from 2008 to 2012.
Nassir (30)	2015	United States	Cohort	Costs of CKD treatment	No association was found between the relative costs of the treatment and the failure of the kidney grafts.
Villarreal-Rios (31)	2014	Mexico	Cross-sectional	Costs of CKD treatment	The high costs of CKD pose a serious problem for healthcare services and families. CAPD is the most cost-efficient option for both.
Satyavani (32)	2014	India	Cross-sectional	The costs for CKD treatment on DM patients	The direct costs of hospital admissions for treating CKD are considerably higher than those of the patients who suffer from the complication.
Lorenzo-Sellares (33)	2014	Spain	Cohort	Costs of CKD treatment	HD is five times more expensive than the treatment for advanced stages of CKD and three times the costs for kidney transplantation.
Moura (34)	2014	Brazil	Environmental	Incidence and prevalence of patients on dialysis who rely on public financing	During the time of the study, there was a constant increase in incidence, and prevalence rose, especially amongst the elderly.
Gador-Whyte (35)	2014	Australia	Cross-sectional	Costs for implementing protocols for CKD and DM treatment	Adherence to best practices for DM and CKD treatment was compromised by inadequate financing and matters related to the workforce.
Karopadi (36)	2014	Italy	Meta-analysis	Costs of CKD treatment	Even in the absence of a market for the local production of PD equipment, it is possible for a country to save with the provision of PD.
Vupputuri (37)	2014	United States	Retrospective cohort	The costs for CKD treatment on DM patients	The progression of CKD in DM type 2 patients substantially increases treatment costs.
Kadam (38)	2013	England	Cross-sectional	Treatment costs for chronic diseases	Multimorbidity is associated with a broad variety of treatments and different costs. CKD is one of the diseases with the highest and most expensive impact in healthcare.
Coentrão (39)	2013	Portugal	Retrospective cohort	Costs of CKD treatment	Compared with HD, PD requires fewer resources over the first year of treatment.
Essue (40)	2013	Australia	Cross-sectional	Costs of CKD treatment	A considerable proportion of the patients face difficulties due to the high costs associated with the treatment and managing od CKD.
Erdem (41)	2013	United States	Cross-sectional	Treatment costs for chronic diseases	People with chronic diseases represent a disproportionate share of Medicare payments, both for Part A and for Part B, over a period of two years. CKD is among the most expensive chronic diseases, in both parts.
Ramachandran (42)	2013	India	Cohort	Costs of CKD treatment	Kidney transplant is associated with catastrophic spendings and leads most patients who are treated in a public hospital to a serious financial crisis, as well as to school evasion and loss of employment.
Chiroli (43)	2012	Multicenter (Europe)	Retrospective cohort	Costs of CKD treatment	Secondary hyperparathyroidism increases the financial burden of CKD in Europe.
Kerr (44)	2012	England	Cross-sectional	Costs of CKD treatment	The financial impact of CKD is high, with high costs related to RRT and cardiovascular complications.

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[1] CORRESPONDING AUTHOR: Geraldo Bezerra da Silva Junior, Universidade de Fortaleza - Unifor, Av. Washington Soares, 1321, Bloco S, Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil - CEP 60811-905 E-mail: geraldobezerrajr@yahoo.com.br