Evolução clínica dos pacientes com doença renal crônica estágio 3b em fila de espera para consulta com nefrologia no Sistema Único de Saúde (SUS)

Abstract

Background: Chronic kidney disease (CKD) is increasing in prevalence and importance as a global public health problem. The proper management of these patients from primary care to specialized atention, according to sugestions of guidelines is essential to slow up the progression of the disease. Objectives: To evaluate the care, request for tests and the evolution of the renal function of patients with CKD 3b referred by the general practitioner to the nephrologist in the Unified Health System (SUS), while on the waiting list for care, regarding compliance with clinical guidelines for the care of people with CKD. Methods: Retrospective cohort study that evaluated patients with CKD stage 3b (30 and 44 ml/min/1.73m² of glomerular filtration rate -GFR), queuing for care with nephrologist in the Brazilian Public Health System [SUS], from January 2018 to January 2020. Electronic records were evaluated [sociodemographic data, laboratory parameters, and comorbidities] for a period of 5 years, based on suggestions of kidney disease: Improving Global Outcome (KDIGO) 2012. The results were compared before the consultation with the nephrologist, called the pre group, and after the medical consultation with this specialist, called the post group. Results: A total of 211 patients with a mean age of 74±12 years were included. About a half were brown, overweight or obese. A total of 160 patients (75.8%) were hypertensive and 99 (46.9%) were diabetic, and 80% received a prescription for a renin-angiotensin-aldosterone system blocker. There was no worsening of renal function, and results for laboratory parameters were better than those expected based on the KDIGO guidelines. It’s importante to note that general practitioners and nephrologists did not ordered the tests as planned and the goals for the underlying disease were not achieved. Conclusion: According do the data evaluated,not all general practitioners follow the completely suggested guidelines, nor do they reach the clinical control goals for the underlying diseases, they do not request all the expected tests. It also was found from nephrological care. However, this fact does not seem to have an impact on the patients studied, on the evolution of the kidney disease, on the incidence of anemia, on the ionic disturbance or on albuminuria for stage 3b. Thus, these results suggest that this patient can be maintained under follow up with a general practitioner, but with improvement in permanent education policies, matrix support by a nephrologist and greater proximity to specialized care.