BRAZILIAN DIALYSIS 2024: NETWORK NATIONAL BENCHMARKING OF VASCULAR ACCESS, MODALITY, AND ADEQUACY

 

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https://storage.unitedwebnetwork.com/files/1099/469e64cc3d618125c62045afc5d03df1.pdf
BRAZILIAN DIALYSIS 2024: NETWORK NATIONAL BENCHMARKING OF VASCULAR ACCESS, MODALITY, AND ADEQUACY

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Bruno
Zawadzki
Bruno Zawadzki bruno.zawadzki-ext@davita.com DaVita Brazil Medical Service Rio de Janeiro Brazil *
Marcelo Lopes marcelo.lopes-ext@davita.com DaVita Brazil Medical Service Salvador Brazil -
Fernanda Coelho fernanda.coelho-ext@davita.com DaVita Brazil Medical Service Salvador Brazil -
Rogerio Passos rogerio.passos-ext@davita.com DaVita Brazil Medical Service São Paulo Brazil -
Ana Vieira ana.vieira-ext@davita.com DaVita Brazil Medical Service São Paulo Brazil -
Bruna Rodrigues bruna.rodrigues-ext@davita.com DaVita Brazil Medical Service São Paulo Brazil -
Cristina Pinto cristina.pinto-ext@davita.com DaVita Brazil Medical Service Belém Brazil -
Danilo Cunha danilo.cunha-ext@davita.com DaVita Brazil Medical Service Lodrina Brazil -
Fabio Reis fabio.reis-ext@davita.com DaVita Brazil Medical Service Brasília Brazil -
Priscila Lustoza priscila.lustoza-ext@davita.com DaVita Brazil Medical Service Rio de Janeiro Brazil -
 
 
 
 
 

Benchmarking a large network against national data can surface actionable gaps in dialysis delivery. We compared 2024 outcomes from DaVita Brazil clinics with the Brazilian Society of Nephrology (SBN) census 2024.

Cross-sectional analysis of aggregated 2024 data. Samples: DaVita (n=19,741 patients; 100 units) and SBN (n=76,946). Denominators: total patients for modality/adequacy; extracorporeal dialysis (HD+HDF) for vascular access. Proportions were compared with two-sided tests of two independent proportions (α=0.05). We report p<0.05 only for pre-specified, clinically relevant comparisons: HDF%, short-term CVC%, graft%, Kt/V<1.2%, and Hb<10%.

Modality mix. DaVita adopted HDF more widely than SBN: 12.3% vs 7.1% (p<0.05). HD shares were 83.4% vs 87.3%, PD 4.4% vs 5.6% (descriptive).

Vascular access (HD+HDF). DaVita vs SBN: AVF 64% vs 65% (descriptive); tunneled CVC 24% vs 23% (descriptive); short-term CVC 2% vs 8% (p<0.05); graft 10% vs 4% (p<0.05). Within-network trend 2021→2024 showed a fall in short-term CVC (6%→2%) and rise in AVF (60%→64%).

Adequacy/quality (non-conformity). DaVita showed lower underdialysis: Kt/V<1.2: 12% vs 24% (p<0.05), and fewer patients with anemia below target: Hb<10 g/dL: 27% vs 31% (p<0.05). Other markers were descriptive: albumin<3.5 g/dL 6% vs 10%; P>5.5 mg/dL 33% vs 33%; PTH>600 pg/mL 24% vs 21%; K≥6 mEq/L 20% vs 19%.

Baseline diagnoses (descriptive). Hypertension 31% vs 29%; diabetes 28% vs 29%; glomerulonephritis 8% vs 7%; polycystic kidney disease 4% vs 4%; undefined etiology 15% vs 19%.


In 2024, DaVita Brazil demonstrated greater HDF uptake, substantially fewer short-term catheters, and higher graft use than the national benchmark, alongside better adequacy (lower Kt/V<1.2) and fewer patients with Hb<10 g/dL. Priorities include sustaining the low short-term catheter rate while closing the small gaps in AVF and tunneled CVC mix, and targeted mineral-bone and potassium management. Findings support focused access-governance and adequacy bundles that are scalable in mixed public–private settings.

Kewords