Abstract
INTRODUCTION: Globally, quantitative information on healthcare coverage for chronic kidney disease (CKD) is scarce. Our objective was to estimate the supply/demand ratio for CKD-related procedures in the Brazilian Unified Health System (SUS) between 2015 and 2024. METHODS: The volume of tests, consultations and treatments related to CKD was retrieved from the website of the SUS Information Technology Department. The requirement parameters of these procedures were obtained from the Ministry of Health ordinances as well as from literature review. The percentage coverage of each procedure was defined by the ratio between the volume performed and the estimated need. RESULTS: Coverage of the following procedures increased between 2015 and 2024: serum creatinine dosage (70% to 122%), proteinuria testing (4% to 12%), kidney ultrasonography (76% to 107%), outpatient consultation with a nephrologist (48% to 164%), multidisciplinary care of pre-dialysis CKD (0% to 3%), and chronic dialysis (69% to 81%). Coverage of kidney biopsy remained nearly stable (19% to 21%). There was a reduction in coverage of arteriovenous fistula for hemodialysis (HD) (66% to 59%) and of kidney transplantation (46% to 37%). The use of peritoneal dialysis (PD) among chronic dialysis methods (PD and HD) declined from 7% to 4%. CONCLUSION: Possible explanations for these results include excessive creatinine testing and nephrology consultations, neglect of CKD screening for proteinuria, lack of adherence to multidisciplinary pre-dialysis follow-up, underutilization of PD, and insufficient availability of kidney biopsy and kidney replacement therapy (lower coverage of kidney transplantation compared to chronic dialysis).