title: Dialysis for end stage renal disease financed through the Brazilian National Health System, 2000 to 2012.
abstract: BACKGROUND
  Chronic kidney disease has become a public health problem worldwide. Its terminal stage requires renal replacement therapy--dialysis or transplantation--for the maintenance of life, resulting in high economic and social costs. Though the number of patients with end-stage renal disease treated by dialysis in Brazil is among the highest in the world, current estimates of incidence and prevalence are imprecise. Our aim is to describe incidence and prevalence trends and the epidemiologic profile of end-stage renal disease patients receiving publically-financed dialysis in Brazil between 2000 and 2012.
  
  
  METHODS
  We internally linked records of the High Complexity Procedure Authorization/Renal Replacement Therapy (APAC/TRS) system so as to permit analyses of incidence and prevalence of dialysis over the period 2000-2012. We characterized temporal variations in the incidence and prevalence using Joinpoint regression.
  
  
  RESULTS
  Over the period, 280,667 patients received publically-financed dialysis, 57.2% of these being male. The underlying disease causes listed were hypertension (20.8%), diabetes (12.0%) and glomerulonephritis (7.7%); for 42.3%, no specific cause was recorded. Hemodialysis was the therapeutic modality in 90.1%. Over this period, prevalence increased 47%, rising 3.6% (95% CI 3.2%-4.0%)/year. Incidence increased 20%, or 1.8% (1.1%-2.5%)/year. Incidence increased in both sexes, in all regions of the country and particularly in older age groups.
  
  
  CONCLUSIONS
  Incidence and prevalence of end-stage renal disease receiving publically-financed dialysis treatment has increased notably. The linkage approach developed will permit continuous future monitoring of these indicators.
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. moural@paho.org.
authors.forename: Lenildo
authors.initials: L
authors.lastname: de Moura
authors.forename: Isaías Valente
authors.initials: IV
authors.lastname: Prestes
authors.forename: Bruce Bartholow
authors.initials: BB
authors.lastname: Duncan
authors.forename: Fernando Saldanha
authors.initials: FS
authors.lastname: Thome
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000639:trends*; D006435:Renal Dialysis / Q000191:economics* / Q000639:trends*; D055815:Young Adult