Prevalence of Patients Receiving Publicly Funded Renal Replacement Therapy in Brazil: Regional Inequities and Costs

Augusto Cesar Soares dos Santos Junior1, 2, 3, *, Fernando das Mercês Lucas Junior1, 3, Kátia de Paula Farah1, 3, Ana Carolina Aguiar do Nascimento1, José Luiz Santos Nogueira1, Carlos Faria Santos Amaral1, Silvana Marcia Bruschi Kelles1, 2
1 Núcleo de Avaliação de Tecnologias em Saúde do Hospital das Clínicas, Universidade Federal de Minas Gerais (NATS HC UFMG), Brazil
2 Unimed-BH, Grupo de Avaliação de Tecnologias em Saúde, Gerais, Brazil
3 Nephrologist at Hospital das Clinicas - UFMG, Gerais, Brazil

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© Soares dos Santos Junior et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Núcleo de Avaliação de Tecnologias em Saúde do Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Av Alfredo Balena 110, Belo Horizonte, Minas Gerais, Brazil, Zip 30.130-100; Tel: +55 31-3409-9384; E-mail:



In recent years, the number of patients with end-stage renal disease has rapidly increased worldwide. In Brazil, recent surveys have undisclosed a trend towards an increase in the prevalence of this condition.

Aims and Objectives:

This study aimed at describing the prevalence of patients with end-stage renal disease (ESRD) receiving publicly funded dialysis in Brazil.

Methods asnd Materials:

Data concerning the prevalence and mortality of patients with ESRD being provided renal replacement therapy by the SUS from 2008 to 2013 were collected at the DATASUS databank (, the Authorization System for High Complexity/Cost Procedures (APAC) database, the SUS Ambulatory Information System (SIA) and the Mortality Information System (SIM) database.


From 2008 to 2013 there was a 25% increase in the absolute number of hemodialysis sessions (10,022,962; 12,561,623). This resulted in an estimated overall increase of 18% in the ratio of patients on hemodialysis per million population (352 pmp; 416 pmp). There were considerable differences among Brazilian States regarding the prevalence of patients with ESRD on hemodialysis. In 2013, the prevalence ranged from 173 pmp (State of Amazonas) to 531 pmp (State of Minas Gerais). The leading Brazilian States, in absolute number of patients, were São Paulo (19,301), Minas Gerais (10,940) and Rio de Janeiro (8,510), all of them in the southeast region. In 2013, the overall mean mortality rate was 18.4%. From 2008 to 2013, the renal transplantation rate increased from 35.2 to 41.6 transplants per year per million inhabitants. In 2013, hemodialysis was the most frequent modality of therapy, corresponding to 87.1% of the cases, followed by CAPD (9.2%) and APD (3.7%).


In Brazil, chronic kidney disease is steadily increasing in prevalence and rapidly becoming a major public health concern. Therefore, policies towards prevention and strategies to avoid underdiagnose and assure broad access to renal replacement therapy should be strengthened nationwide.

Keywords: Brazil, End-stage renal disease (ESRD), Publicly funded renal replacement therapy, Regional inequities, Sistema Unico de Saude (SUS).