Dutra et al.11 Dutra MC, Uliano EJM, Machado DFGDP, Martins T, Schuelter-Trevisol F, Trevisol DJ. Avaliação da função renal em idosos: um estudo de base populacional. J Bras Nefrol 2014;36:297-303. reported a 13.6% prevalence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (GFR) lower than 60 ml/min/1.73 m2. Their study brought about a huge contribution to quantify and identify a large number of individuals with CKD in the more susceptible population - the elderly. The results achieved may help local managers plan and execute programs to prevent CKD and properly care for patients with it, especially considering the high coverage of the family healthcare program from the public health care system in that city.
However, this analysis is only applied to the region where the study was carried out and, therefore, we should not simply extrapolate these results and estimate figures for the rest of the country based on this series. The population investigated, reflecting the ethnical population of the state of Santa Catarina, which is significantly different from that of the rest of the country, because of the strong predominance of Caucasians. The higher risk of renal failure and the need for substitute renal therapy is well known among African descendants, at least in the USA.22 US Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2013. Thus, it is acceptable to assume that CKD prevalence may be even higher in regions of the country with a larger population of African descent. Other local factors may also influence CKD prevalence, such as the level of coverage of programs geared towards the treatment of diabetes and hypertension. In the case of the city where this study was carried out, more than 90% of the elderly population was enlisted in the Family healthcare program. In the cities with low coverage, we can expect to see a higher prevalence of late complications of diabetes and hypertension, including CKD.
Further epidemiological studies involving CKD, both regional and national, are very much welcome. It is not reasonable that we should use statistics from other countries with different populations and healthcare systems. Understanding the true prevalence of CKD in Brazil must include not only a classification per stage according to the GFR, but also go more in depth in stratifying the risk of kidney disease progression, combining GFR estimates with albuminuria presence and magnitude.33 Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013;3:1-150.
Finally, it is worth stressing that the elderly have a higher prevalence of CKD - that
is why it was appropriate to involve this population stratum in our study. Nonetheless,
since many elderly have a moderate GFR reduction, in the 3a (45-59 ml/min) stage for
instance, and usually have a slow progression of their CKD, most will die of other
causes before they develop kidney failure.44 Yang W, Xie D, Anderson AH, Joffe MM, Greene T, Teal V, et al.; CRIC
Study Investigators. Association of kidney disease outcomes with risk factors for
CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney
Dis 2014;63:236-43. DOI:
http://dx.doi.org/10.1053/j.ajkd.2013.08.028
http://dx.doi.org/10.1053/j.ajkd.2013.08...
On
the other hand, hypertension and diabetes are still the main causes of CKD, causing
kidney failure and the need for kidney replacement therapy in Brazil, bringing a huge
burden to our healthcare system. The mean age of patients who start dialysis in Brazil
is only 52 years.55 Matos JP, Almeida JR, Guinsburg A, Marelli C, Barra AB, Vasconcellos MS,
et al. Assessment of a five-year survival on hemodialysis in Brazil: a cohort of
3,082 incident patients. J Bras Nefrol 2011;33:436-41. Thus, it seems proper that
epidemiological studies like this must include younger diabetic and hypertensive
patients when the goal is to find individuals who can still benefit from actions to
delay CKD progression.
In conclusion, for a proper CKD approach in terms of healthcare public policies in
Brazil we need to progress further in understanding the impact of CKD in our country.
This study carried out with the elderly population from the city of Tubarão - SC brings
its contribution, but we need more studies similar to this one, involving populations
from other regions and other groups - besides the elderly - with high risk for
developing CKD, such as hypertensive and diabetic patients. A true understanding of the
real problem in our country will only be achieved when we employ strategies of
population studies, similarly to what is used in developed countries.66 Vart P, Gansevoort RT, Coresh J, Reijneveld SA, Bültmann U.
Socioeconomic measures and CKD in the United States and The Netherlands. Clin J Am
Soc Nephrol 2013;8:1685-93. DOI: http://dx.doi.org/10.2215/CJN.12521212
http://dx.doi.org/10.2215/CJN.12521212...
Referências
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1Dutra MC, Uliano EJM, Machado DFGDP, Martins T, Schuelter-Trevisol F, Trevisol DJ. Avaliação da função renal em idosos: um estudo de base populacional. J Bras Nefrol 2014;36:297-303.
-
2US Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2013.
-
3Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013;3:1-150.
-
4Yang W, Xie D, Anderson AH, Joffe MM, Greene T, Teal V, et al.; CRIC Study Investigators. Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis 2014;63:236-43. DOI: http://dx.doi.org/10.1053/j.ajkd.2013.08.028
» http://dx.doi.org/10.1053/j.ajkd.2013.08.028 -
5Matos JP, Almeida JR, Guinsburg A, Marelli C, Barra AB, Vasconcellos MS, et al. Assessment of a five-year survival on hemodialysis in Brazil: a cohort of 3,082 incident patients. J Bras Nefrol 2011;33:436-41.
-
6Vart P, Gansevoort RT, Coresh J, Reijneveld SA, Bültmann U. Socioeconomic measures and CKD in the United States and The Netherlands. Clin J Am Soc Nephrol 2013;8:1685-93. DOI: http://dx.doi.org/10.2215/CJN.12521212
» http://dx.doi.org/10.2215/CJN.12521212
Publication Dates
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Publication in this collection
Jul-Sep 2014
History
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Received
01 Aug 2014 -
Accepted
05 Aug 2014