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Sérgio Veloso Brant Pinheirohttp://lattes.cnpq.br/5774807031990521Mariângela Leal Cherchigliahttp://lattes.cnpq.br/6739544920203518Ana Cristina Simões e SilvaMarcelo de Sousa TavaresSônia Maria SoaresAna Paula Pinheiro Chagas FernandesLorena Nascimento Girardi Madeirahttp://lattes.cnpq.br/5744654296175878Celina de Faria Rezende2024-02-29T13:04:41Z2024-02-29T13:04:41Z2023-08-28http://hdl.handle.net/1843/649400000-0002-7450-2375Introdução: A doença renal crônica (DRC) é uma condição grave que afeta cerca de 1 a 3% das crianças e adolescentes no mundo, sendo as anomalias congênitas dos rins e do trato urinário (ACRTU) as principais causas nessa população. A DRC pode progredir para o estágio 5, em que o paciente necessita de terapia renal substitutiva (TRS). A TRS inclui a hemodiálise, a diálise peritoneal e o transplante renal. Objetivos: O presente estudo descreve as características e os desfechos de pacientes pediátricos com doença renal crônica (DRC) que iniciaram terapia renal substitutiva (TRS) pelo Sistema Único de Saúde brasileiro entre 2002 e 2014. Métodos: Foi realizado um estudo de coorte retrospectivo utilizando dados secundários do Registro Nacional de Terapia Renal Substitutiva, que incluiu 7.544 pacientes com idade entre 0 e 17 anos e 11 meses. Os principais desfechos avaliados foram o transplante renal e a ocorrência de óbito. Resultados: Os pacientes eram majoritariamente homens, brancos e adolescentes, com idade mediana de 13 anos. A hemodiálise foi a TRS mais usada, com 36,5% dos pacientes com fístula arteriovenosa. Em 38,4% dos casos, ocorreu transplante renal, com mediana de tempo de seguimento de 70 meses, e 12,7% morreram durante o período de acompanhamento. O transplante renal, especialmente o preemptivo, foi o principal fator que reduziu o risco de óbito. Outros fatores que influenciaram positivamente o transplante e a sobrevida foram o sexo masculino, ser da região sul do Brasil e receber tratamento fora da macrorregião de residência. O tratamento dialítico apresentou maior risco de óbito. Conclusão: Os pacientes pediátricos com DRC devem ser transplantados o mais rapidamente possível, preferencialmente preemptivo, e passar o menor tempo possível em diálise. A epidemiologia da DRC em crianças e adolescentes é um campo em evolução, essencial para orientar as políticas de saúde pública e as práticas clínicas voltadas para a prevenção, o diagnóstico precoce e o tratamento dessa doença complexa. Introduction: Chronic kidney disease (CKD) is a serious condition that affects about 1 to 3% of children and adolescents worldwide, with congenital anomaly of the kidney and urinary tract (CAKUT) being the main cause in this population. CKD can progress to stage 5, in which the patient requires renal replacement therapy (RRT). RRT includes hemodialysis, peritoneal dialysis and kidney transplantation. Objectives: The present study describes the characteristics and outcomes of pediatric patients with chronic kidney disease (CKD) who started renal replacement therapy (RRT) by the Brazilian Unified Health System between 2002 and 2014. Methods: a retrospective cohort study was carried out using secondary data from the National Registry of Renal Replacement Therapy, which included 7,544 patients aged between 0 and 17 years and 11 months. The main outcomes evaluated were kidney transplantation and occurrence of death. Results: Patients were mostly male, white and adolescents, with a median age of 13 years. Hemodialysis was the most used RRT, with 36.5% of patients with arteriovenous fistula. In 38.4% of cases, kidney transplantation occurred, with a median follow-up time of 70 months, and 12.7% died during the follow-up period. Kidney transplantation, especially preemptive, was the main factor that reduced the risk of death. Other factors that positively influenced transplantation and survival were male sex, being from the southern region of Brazil and receiving treatment outside the macroregion of residence. Dialytic treatment presented a higher risk of death. Conclusion: Pediatric patients with CKD should be transplanted as soon as possible, preferably preemptive, and spend as little time as possible on dialysis. The epidemiology of CKD in children and adolescents is an evolving field, essential to guide public health policies and clinical practices aimed at preventing, early diagnosing and treating this complex disease.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências da Saúde - Saúde da Criança e do AdolescenteUFMGBrasilMED - DEPARTAMENTO DE PEDIATRIAhttp://creativecommons.org/licenses/by-nd/3.0/pt/info:eu-repo/semantics/openAccessInsuficiência Renal CrônicaTerapia de Substituição RenalCriançaAdolescenteTransplanteMorteinsuficiência renal crônicaterapia renal substitutivacriançaadolescentetransplanteóbitoTransplante e óbito em crianças e adolescentes em terapia renal substitutiva no Sistema Único de Saúde, no Brasil, de 2002 a 2014info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALDOUTORADO+FINAL+-06-02-24.pdfDOUTORADO+FINAL+-06-02-24.pdfapplication/pdf3454426https://repositorio.ufmg.br/bitstream/1843/64940/1/DOUTORADO%2bFINAL%2b-06-02-24.pdf693fa8380a8f1bc6e9e4260af3198d8eMD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8805https://repositorio.ufmg.br/bitstream/1843/64940/2/license_rdf00e5e6a57d5512d202d12cb48704dfd6MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/64940/3/license.txtcda590c95a0b51b4d15f60c9642ca272MD531843/649402024-02-29 10:04:41.88oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2024-02-29T13:04:41Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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