Pediatric Chronic Dialysis in Brazil: Epidemiology and Regional Inequalities

Abstract

IntroductionThere are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and great need for continuous attention of specialized services with high demand for complex and costly procedures.ObjectiveThe aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey.Materials and MethodsA cross-sectional study was performed in a representative sample of dialysis centers (nc = 239) that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708). We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers’ leaders.ResultsWe estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp) (95% CI: 14.8–25.3) and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8–8.4). The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3–48.1) and 11.0 (95% CI: 2.8–19.3) cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2–21.4), and in the Northeast region, 3.8 (95% CI: 1.4–6.3) cases pmarp, respectively.ConclusionBrazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint strategies aiming to reduce inequities and improving access to treatment and adequacy of services across the Brazilian regions are necessary to provide an appropriate care setting for this population group.

Inequality in pediatric kidney transplantation in Brazil

“…It could be argued that the chance of transplantation in the North/Midwest regions is lower because the incidence of ESRD is also lower, but recent data from our group on the epidemiology of pediatric ESRD in Brazil rule out this possibility [15]. Together, these data indicate that the North and the Midwest regions of Brazil have children with the lowest access to transplantation and this clearly depicts the inequalities that exist in the country.…”

Hemodialysis versus peritoneal dialysis in resource-limited settings

“…Brazil, which shares a similar diversity in socioeconomic, cultural and regional profiles with Asia, reported a low prevalence of children on dialysis [32]. In India, nearly one quarter of children with chronic kidney disease (CKD) present with ESKD at the time of diagnosis [33].…”

Inequalities in access to pediatric ESRD care: a global health challenge

“…In an article recently published in Pediatric Nephrology, they report that, despite a nationally regulated allocation system, children from the North and the Midwest macroregions of Brazil have a 3-4 times lower probability of getting a deceased donor transplant than children from the South and Southeast macroregions [3]. It is argued that this is not compensated by a higher living donor transplant rate and nor does it completely reflect the underlying disparities in pediatric ESRD incidence [31]. Although the authors found an association between gross domestic product per capita and access to transplantation, the differences were only partly related to regional wealth.…”