Kidney Replacement Therapy in Brazil: A Retrospective Cohort Study Based on Analysis of the Brazilian Public Health System.

Abstract

Background: Brazil has the largest Public Health System providing universal coverage for chronic dialysis. The objective was to describe the number, sociodemographic, and clinical characteristics of patients undergoing kidney replacement therapy (KRT) by dialysis within the Public Health System in Brazil.

Methods: We carried out a retrospective cohort study analyzing the database from the Brazilian Public Health System, focusing on procedures related to KRT. The study encompassed both prevalent and incident patients who underwent KRT in Brazil between 2015 and 2023.

Results: We observed an increase in the number and prevalence rate of dialysis patients from 2015 to 2023. We also noticed an increase in the age at dialysis initiation and in the prevalence of mixed-race patients and a reduction in the proportion of those undergoing peritoneal dialysis and with arteriovenous fistula. We identified an upward trajectory in the values of single-pool Kt/V over the years, contrasting with a decline in hemoglobin levels. The overall estimated prevalence rate of dialysis patients increased from 654 per million population (pmp) to 792 pmp over the years. The survival rates of incident KRT patients at 12 and 96 months were 81% and 60%, respectively.

Conclusion: We reported an increase in the age at which dialysis began and a decline in the adoption of peritoneal dialysis over the years. While there have been some improvements over the years resulting in better adequacy of hemodialysis as measured by Kt/V, controlling certain parameters such as hemoglobin levels has remained challenging.