Epidemiology Of Vascular Access For Outpatient Hemodialysis Procedures And Renal Transplantation In Brazil Between 2008 And 2022: A National Cross-Sectional Analysis

3.BACKGROUND AND HYPOTHESISChronic kidney disease (CKD) represents a significant global public health challenge, affecting up to 13.4% of the population and ranking as the third fastest-growing cause of mortality. Progression of CKD to end stage kidney disease (ESKD) is the initial milestone for renal replacement therapy, which includes hemodialysis and renal transplantation, the latter marking the final therapy for ESKD patients. Arteriovenous fistulas (AVFs) are preferred for hemodialysis due to lower infection risks and superior patency compared to long-staying tunneled catheters (LSTC). Despite the importance of vascular access and transplantation, nationwide data correlating their utilization over time remains scarce. This study aimed to analyze outpatient hemodialysis vascular access procedures in Brazilian public health system from 2008 to 2022, comparing the temporal trends with renal transplantation. METHODSThis study employed a cross-sectional, population-based analysis of publicly available data pertaining outpatient vascular access procedures for hemodialysis and renal transplantation in the brazilian public health system between 2008 and 2022. Linear regression and correlation between both were then carried out. RESULTSBetween 2008 and 2022, 937,739 procedures were realized, including vascular access confection, ending procedures and renal transplants. Arteriovenous fistulas accounted for the majority of procedures (55%), followed by LSTC (34%), renal transplants in cadaveric donors (5.6%), catheter removals (2.2%), renal transplants with living donors (1.6%) and fistula ligation (1.4%). The increase in AVF creation was not proportional to the growth of the hemodialysis population (p<0.001), in contrast to catheter implants, which increased substantially over the study period (p<0.001). Vascular access-ending procedures demonstrated a significant correlation with renal transplants (p<0.001). CONCLUSIONIn Brazil, the number of LSTC for hemodialysis has increased over the years, while the number of AVFs significantly decreased. Additionally access-ending procedures, such as fistula ligation and catheter removals, have risen annually since 2010 and demonstrated a correlation with renal transplantation. Key Points: