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. 2018 Apr-Jun;40(2):122-129.
doi: 10.1590/2175-8239-JBN-3918. Epub 2018 Jun 4.

Expenses of the Brazilian Public Healthcare System with chronic kidney disease

[Article in English, Portuguese]
Paulo Roberto Alcalde  1 , Gianna Mastroianni Kirsztajn  1
Affiliations

Expenses of the Brazilian Public Healthcare System with chronic kidney disease

[Article in English, Portuguese]
Paulo Roberto Alcalde et al. J Bras Nefrol. 2018 Apr-Jun.

Abstract
in English, Portuguese

Introduction: The prevalence of chronic kidney disease (CKD) is increasing worldwide, with costs that can be impeditive.

Objective: To establish the expenses of the Brazilian Public Healthcare System (SUS), with hospitalizations due to CKD and related diseases; evaluating expenses with renal replacement therapy (RRT).

Methods: We have assessed the values paid by the SUS in the triennium 2013-2015, for estimating annual expenses with CKD treatment and hospitalization, associated diseases, and exams.

Results: There was an increase in hospitalization by all causes in Brazil during this triennium. CKD and associated diseases corresponded to 1.82% and 5.79% of hospitalizations due to all causes in Brazil, and 2.87% and 10.10% of all expenses, respectively. Kidney grafts from deceased donors corresponded to 76% of hospitalizations and 80% of expenses with transplantation. There was a decrease in transplantation from living donors. There was an increase in the number of exams of 11.94% and of 10.95% in the expenses. There was a decrease in the number of procedures and expenses in intermittent peritoneal dialysis (IPD) and related procedures; but other procedures increased. Hemodialysis (3 weekly sessions) corresponded to 95.96% of procedures and 96.07% of expenses with dialysis in general.

Conclusion: Renal diseases and some of the main related diseases corresponded to 12.97% of the expenses in the triennium 2013-2015, and RRT to more than 5% of the SUS expenses with medium and high complexity healthcare. Such high expenses determine great concerns on the future maintenance of treatment for stage-5 CKD in Brazil and countries in similar or worse conditions of development.

Introdução:: A prevalência de doença renal crônica (DRC) está aumentando em todo o mundo, com custos que podem ser impeditivos.

Objetivo:: Estabelecer os gastos do Sistema Único de Saúde (SUS) com internação hospitalar por DRC e doenças relacionadas; avaliar os gastos com terapia renal substitutiva (TRS).

Métodos:: Avaliamos os valores pagos pelo SUS no triênio 2013-2015, para estimar as despesas anuais com tratamento da DRC e internação por DRC, doenças associadas e exames.

Resultados:: Houve aumento da hospitalização por todas as causas no Brasil neste triênio. A DRC e as doenças associadas corresponderam a 1,82% e 5,79% das internações hospitalares por todas as causas no Brasil, e 2,87% e 10,10% de todas as despesas, respectivamente. Os enxertos renais com doadores falecidos corresponderam a 76% das internações e 80% das despesas com o transplante. Houve uma diminuição em transplantes de doadores vivos. Houve um aumento no número de exames de 11,94% e em despesas de 10,95%. Houve uma diminuição no número de procedimentos e despesas em diálise peritoneal intermitente (IPD) e procedimentos relacionados; mas outros procedimentos aumentaram. A hemodiálise (3 sessões semanais) correspondeu a 95,96% dos procedimentos e 96,07% dos gastos com diálise em geral.

Conclusão:: As doenças renais e algumas das principais doenças relacionadas corresponderam a 12,97% das despesas no triênio 2013-2015 e a TRS a mais de 5% das despesas do SUS com atenção à saúde de média e alta complexidade. Tais gastos elevados determinam grandes preocupações quanto à manutenção futura do tratamento da DRC estágio 5 no Brasil e em países em condições de desenvolvimento semelhantes ou piores.

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