Global dialysis perspective: Brazil

Brazil, the largest Latin American country, ranks fifth in the world by both geographic area and population (209.469 million inhabitants in 2018). The annual rate of population growth is 0.82% (1). The population has a mixed ethnicity, with 44% of them self-declared as of white skin color; 10.5% of the inhabitants are over 65 years old, and life expectancy at birth is 75.5 years (1). Although the country has experienced great social and economic development over the last decades, notable inequalities are still present. The southern and southeastern regions concentrate most of the economic resources and industrial, technological, and health care capabilities. The gross national income per capita was US$9140 in 2018. The total expenditure on health per capita in 2016 was US$796, corresponding to 9% of the gross national income (2). In 1974, the Brazilian Public Health System recognized chronic dialysis as a treatment for ESKD, initiating the reimbursement of the procedure. The implementation of a unified public health system in 1993 was a cornerstone in the assertion of the creation of a country-wide permanent program to integrally finance the chronic maintenance dialysis treatment of all patients with ESKD (3). From then on, the program size and the numbers of patients and clinics have progressively increased. Over the years, Brazil has been ranked third in the world in the number of patients undergoing dialysis. The Brazilian Society of Nephrology has been annually monitoring the epidemiologic data from these patients since 1999 through a national dialysis registry (4⇓–6). In the last surveys, the response rate of the clinics was around 40%, and therefore, caution should be exercised regarding data interpretation. Although there is universal chronic dialysis coverage in Brazil, access to care is not uniform. Some patients with renal failure, particularly the oldest ones (7), those …