Abstract
BackgroundChronic kidney disease has become a public health problem worldwide. Its terminal stage requires renal replacement therapy – dialysis or transplantation – for the maintenance of life, resulting in high economic and social costs. Though the number of patients with end-stage renal disease treated by dialysis in Brazil is among the highest in the world, current estimates of incidence and prevalence are imprecise. Our aim is to describe incidence and prevalence trends and the epidemiologic profile of end-stage renal disease patients receiving publically-financed dialysis in Brazil between 2000 and 2012.MethodsWe internally linked records of the High Complexity Procedure Authorization/Renal Replacement Therapy (APAC/TRS) system so as to permit analyses of incidence and prevalence of dialysis over the period 2000-2012. We characterized temporal variations in the incidence and prevalence using Joinpoint regression.ResultsOver the period, 280,667 patients received publically-financed dialysis, 57.2% of these being male. The underlying disease causes listed were hypertension (20.8%), diabetes (12.0%) and glomerulonephritis (7.7%); for 42.3%, no specific cause was recorded. Hemodialysis was the therapeutic modality in 90.1%. Over this period, prevalence increased 47%, rising 3.6% (95% CI 3.2% - 4.0%)/year. Incidence increased 20%, or 1.8% (1.1% – 2.5%)/year. Incidence increased in both sexes, in all regions of the country and particularly in older age groups.ConclusionsIncidence and prevalence of end-stage renal disease receiving publically-financed dialysis treatment has increased notably. The linkage approach developed will permit continuous future monitoring of these indicators.
Highlights
Chronic kidney disease has become a public health problem worldwide
In Brazil, expenses related to publicallyfinanced renal replacement therapy are reimbursed through the High Complexity Procedure Authorization/Renal Replacement Therapy (Autorização de Procedimentos de Alta Complexidade/Terapia Renal Substitutiva, or APAC/TRS) subsystem of the Outpatient Information System (Sistema de Informação Ambulatorial, or SIA) [4]
We evaluated all patients with end stage renal disease undergoing dialysis financed through the SUS between January 1, 2000, and December 31, 2012, applying deterministic and probabilistic record linkage techniques to existing data files received from the Ministry of Health, as has been previously described [4]
Summary
Chronic kidney disease has become a public health problem worldwide. Its terminal stage requires renal replacement therapy – dialysis or transplantation – for the maintenance of life, resulting in high economic and social costs. The increase in the number of individuals globally with chronic kidney disease has stimulated the implementation of public policies to address this condition These in turn require surveillance strategies designed to capture information relevant to prevention and treatment. APAC/TRS receives and records data for the approximately 84.9% of dialysis patients who are receiving treatment financed through Brazil’s national health system (Sistema Único de Saúde, or SUS) [5] It has not been possible, to date, to regularly monitor the incidence, prevalence, and mortality of end-stage renal disease. The aim of this study is to describe, using this linked database, trends in incidence and prevalence and the epidemiological profile of patients with endstage renal disease receiving publically financed dialysis in Brazil between the years 2000 to 2012
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