Epidemiologia de 376.383 confecções de fístulas arteriovenosas para hemodiálise ao longo de 9 anos no Sistema Único de Saúde e no setor privado brasileiro

BACKGROUND: Chronic kidney disease represents a growing public health challenge worldwide, particularly in low- and middleincome countries. In Brazil, where most patients with end-stage renal disease depend on the public healthcare system for dialysis and transplantation, ensuring adequate vascular access - with arteriovenous fistula (AVF) being one of the available options - is critical to sustaining treatment. Despite its clinical relevance, comprehensive national data on vascular access patterns across both sectors have historically been limited. OBJECTIVE: This study aimed to examine trends in AVF creation for hemodialysis across Brazil from 2015 to 2023, assessing differences in frequency, geographic distribution, and sectoral disparities between the public and private healthcare sectors. METHODS: A retrospective population-based analysis was conducted using anonymized data from national administrative databases: DATASUS (public sector) and D-TISS (private sector). The majority of AVF creation procedures were included. Statistical analyses considered regional adjustments and were performed using SPSS v.20, with significance set at p < 0.001. RESULTS: Over the nine- year period, 376,383 AVF procedures were recorded, with 90.57% occurring in the public sector. While the absolute number of AVF creations increased, the ratio of AVFs per 1,000 dialysis patients showed a declining trend. Regional disparities were evident, with the Southeast and South regions presenting higher procedure rates compared to other areas. The private sector consistently reported lower creation rates. CONCLUSION: Although, separately, dialysis and AVF rates have risen steadily in Brazil, the relative rate between them has shown a decreasing trend over the years. The predominance of AVF procedures in the public system is more pronounced.