Family Income and Survival in Brazilian Peritoneal Dialysis Multicenter Study Patients (BRAZPD): Time to Revisit a Myth?

Background and Objectives Although low socioeconomic status has been considered a contraindication to peritoneal dialysis (PD), no published data clearly link it to poor outcomes. The goal of this study was assessing the effect of income on survival in the Brazilian Peritoneal Dialysis Multicenter Study. Design, setting, participants, & measurements Incident PD patients enrolled in this prospective cohort from December 2004 to October 2007 were divided according to monthly family income. The median age was 59 years, 54% were women, 60% Caucasians, 41% diabetics, and 24% had cardiovascular disease. Most of them were in continuous ambulatory PD, had not received predialysis care, had <4 school years, and had a family income of <5 minimum wage (80%). Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model adjusting the results for age, gender, educational status, predialysis care, first therapy, PD modality, calendar year, and comorbidities. Results There were no differences in technique (log rank test chi(2) = 4.36) and patient (log rank test chi(2) = 2.92) survival between the groups. In the multivariate analysis, low family income remained not associated either to worse technique survival (hazard ratio [FIR] = 1.29; 95% confidence interval [CI] = 0.91 to 1.84) or to patient survival (HR = 1.40; 95% CI = 0.99 to 1.99). Conclusions According to these results, economic status is not independently associated with outcomes in this large cohort and should not be considered a barrier for PD indication. Clin J Am Soc Nephrol 6: 1676-1683, 2011. doi: 10.2215/CJN.09041010