A Comparative Analysis of the BRAZPD Data With the Spanish Dialysis Guidelines: Successes and Failures

Introduction: One aim of evidence based learning is to establish guidelines to reach goals obtained from clinical evidences. Reconciliation of guidelines is desired, however, adaptations should be made for the reality of each country. AIM: To assess the degree of adherence to the therapeutic recommendations proposed by the Spanish dialysis guidelines in a cohort of Brazilian patients on peritoneal dialysis (PD). Patients and Methods: A descriptive, cross-sectional study was performed in prevalent and incident patients on PD (BRAZPD) enrolled between December of 2004 and February of 2007, and followed for >3 months. Demographic, clinical and laboratorial data were assessed using electronic medical records. Results : A total of 3,226 patients were assessed, 2,094 of them were incident, observed for a mean time of 13.6 months. The mean age was 54±19 years (34% were over 65 years), 55% were female, and 64% were white. The main etiology of CKD was diabetic nephropathy (34%), 13% were illiterate, 57% had basic education and 42% of the patients had an income of two minimum wages. Compared to the Spanish guidelines, our patients were older, diabetic, and presented larger number of comorbidities (higher David score). The prevalence of infectious complications was low and there was a good fulfillment of recommended lab targets, with the exception of hemoglobin levels. The survival rates at 26 month were 72% and 75% for incident and prevalent patients, respectively. Conclusion : The standards of care of PD delivered to the patients of BRAZPD are in agreement with those recommended internationally.