Factors associated with acceptance of patients for chronic dialysis

There is evidence suggesting that a number of patients with chronic renal failure (CRF) are not accepted for maintenance dialysis treatment, however, the factors that influence this process are not well known.

Data from patients who died of CRF in the city of São Paulo in 1998 were recorded from death certificates. The International Classification of Diseases, tenth revision, was used to select patients with an underlying cause of death associated with CRF. Patients who received dialysis were identified through the files of the São Paulo State Health Secretariat. Subjects accepted for dialysis or not were compared regarding demographic, socioeconomic factors and primary renal disease.

Of 1225 subjects, 414 (33.8%) received dialysis and 811 (66.2%) did not. The adjusted odds ratio (OR) (95% CI) of not being accepted for dialysis was greater in older (> 65 years; OR: 2.94 (2.28 3.79)) and in younger subjects (<18 years; OR: 3.20 (1.16-8.28)) compared to those aged 18-64 years. Single subjects had a greater chance of not being accepted for dialysis than married individuals (OR: 1.28 (1.01-1.65)). Patients with diabetes were less likely to receive dialysis than those with an unknown cause of renal failure (OR: 1.37 (1.01-1.86)).

Age, underlying cause of renal failure and social support are associated with the acceptance of CRF patients for dialysis. Further studies are necessary to examine interventions to improve the access to treatment for potentially eligible patients.