Epidemiology of 376,383 arteriovenous fistula creations for hemodialysis over 9 years within the Brazilian Unified Public Health System and the Private Healthcare Sector

BackgroundChronic kidney disease (CKD) represents a growing public health challenge worldwide, particularly in low- and middle-income countries. In Brazil, where most patients with end-stage renal disease (ESRD) depend on the public healthcare system for dialysis and transplantation, ensuring adequate vascular access - among the options arteriovenous fistula (AVF) - is critical to sustaining treatment. Despite its clinical relevance, comprehensive national data on vascular access patterns across both public and private sectors have been historically limited. ObjectiveThis study aimed to examine trends in AVF confection for hemodialysis across Brazil from 2015 to 2023, assessing differences in frequency, geographic distribution and sectorial disparities between the public and the private healthcare sector. MethodsA 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 confection procedures were included. Statistical analyses considered regional adjustments and were performed using SPSS v.20, with significance set at p < 0.001. ResultsOver the nine-year period, 376.383 AVF procedures were recorded, with 90,57% occurring in the public sector. While the absolute number of AVF confectioners 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 confection rates. ConclusionAlthough, separately, dialysis and AVFs rates have risen steadily in Brazil, the relative rate between than has decreasing trend over the years. The predominance of AVF procedures in the public system maintains higher when compared with the private sector.