Maintenance of inequity in the provision of chronic dialysis treatment in Brazil

The high rate of people with chronic kidney disease on dialysis is a public health problem, especially in developing countries. To evaluate demographic and socioeconomic changes related to dialysis treatment in Brazil from 2002 to 2019. This descriptive, analytical study reviewed retrospective documentary data. A comparative analysis was conducted on demographic, economic, and social trends, as well as changes in dialysis service provision in Brazil between 2002 and 2019. Correlation analysis between Municipal Human Development Index (HDI-M) and the number of dialysis units was performed. There was an increase in the percentage of the older population (5.3% vs. 9.25%) and in life expectancy at birth (70.8 vs. 75.9 years). The gross domestic product (GDP) increased by 453%; the percentage of investment in public health (below 4%) was stable and the ranking of global Human Development Index decreased (73 vs 84). The increase in the prevalence of patients on chronic maintenance dialysis was greater than the increase in the number of patients in new centers (117.3% vs. 43.9%), with fewer patients receiving treatment in the North and Northeast regions. There was a positive linear correlation between the HDI-M values and the number of dialysis units (R = 0.52; 95% CI: 0.75-0.18; p = 0.006). Despite Brazil's strong economic growth and the drastic demographic changes that occurred during the study period, this progress did not translate into a higher investment in health and equitable access to dialysis treatment across the country.