Pediatric Chronic Dialysis in Brazil: Epidemiology and Regional Inequalities.
BACKGROUND
There 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.


OBJECTIVE
The 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.


METHODS
A 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.


RESULTS
We 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.


CONCLUSIONS
Brazil 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.
Sociedade Hospital Samaritano, Sao Paulo, Brazil; Pediatric Division, Federal Univesity of Sao Paulo, Sao Paulo, Brazil.
Tulio
T
Konstantyner
Sociedade Hospital Samaritano, Sao Paulo, Brazil; Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
Ricardo
R
Sesso
Sociedade Hospital Samaritano, Sao Paulo, Brazil.
Maria Fernanda
MF
de Camargo
Sociedade Hospital Samaritano, Sao Paulo, Brazil.
Luciana
L
de Santis Feltran
Sociedade Hospital Samaritano, Sao Paulo, Brazil; Pediatric Division, Federal Univesity of Sao Paulo, Sao Paulo, Brazil.
Paulo Cesar
PC
Koch-Nogueira
D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors