Key Performance Indicators of Secondary Health Care in Chronic Kidney Disease: Experience in Public and Private Services in the State of São Paulo, Brazil.

The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow-up time ≥ 6 months. Compared to PHP patients ( = 183), UHS patients ( = 276) were older (63.4 vs. 59.7 years, =0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, =0.02) and dyslipidemia (58.3 vs. 38.3%, < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5-42.0] vs. 39.1 [28.6-54.8] mL/min/1.73 m, < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, =0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, =0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; =0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; =0.83), dyslipidemia and LDL-cholesterol < 100 mg/dL (38.3% vs. 49.3%; =0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; =0.16), and 25-OH-vitamin-D > 30 ng/mL (28.4% vs. 36.5%; =0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m; < 0.01). In the multivariate linear mixed-effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, < 0.01; time effect, < 0.01; interaction, < 0.01). Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis.