TRENDS IN DIALYSIS PATIENT PREVALENCE AND OUTCOMES IN THE DAVITA NETWORK: A RETROSPECTIVE ANALYSIS (2021-2024)

Chronic kidney disease (CKD) is a growing global health challenge, affecting an estimated 850 million people worldwide. CKD has become the 7th leading global cause of mortality, even as mortality from other major non-communicable diseases declines. Worldwide, outcomes for dialysis patients remain poor and unequal: in high-income countries 15–20% of patients die within 12 months of starting dialysis, while millions in lower-income regions lack any access to treatment. Brazil is a crucial case study in these trends. It now ranks third globally in dialysis patient count. 

This retrospective study utilized data from the DaVita-Brazil network comprising 97 dialysis clinics. We analyzed DaVita Brazil’s internal dialysis census data (2021–2024), including patient counts, modality mix, vascular access, and outcomes, with July 2024 as the latest cutoff. National benchmarks were obtained from the 2023–2024 SBN dialysis census (aggregated data from ~43% of clinics) for prevalence, modality distribution, vascular access, and mortality. International reference values were drawn from ISN and literatura. We used linear regression to assess time trends and chi-square tests to compare proportions (DaVita vs SBN); P < 0.05 was considered statistically significant. Key metrics compared include dialysis prevalence (patients pmp), crude annual mortality, dialysis modality distribution (hemodialysis vs hemodiafiltration vs peritoneal dialysis), vascular access type, and annual transplant rates.

The DaVita network’s dialysis patient census grew from 13,132 in 2021 to 19,741 in 2024, a 50% increase (exceeding general growth). By mid-2024 DaVita was caring for ~19.7k patients (≈93 pmp of Brazil’s population). This parallels national trends – Brazil’s dialysis prevalence reached ~812 pmp in 2024 (up ~5% from 771 pmp in 2023). DaVita Brazil achieved lower mortality rates than reported national averages. In 2024, DaVita’s crude annual mortality was 14.7%, significantly below the SBN national rate of 16.5% (P < 0.05). Hemodiafiltration (HDF) utilization in DaVita was 12.2% of patients – markedly higher than the 7.1% share nationally (P < 0.05. Conventional hemodialysis remained ~83% of treatments in DaVita vs 87% nationally. Peritoneal dialysis (PD) utilization was slightly lower in DaVita (4.3% of patients) compared to Brazil overall (5.6%). All differences in modality mix were statistically significant (chi-square, P < 0.05). 65% of DaVita hemodialysis patients used an arteriovenous fistula, matching the Brazilian national average of 65%. This represents an improvement for DaVita from 2021, when 60% of its HD patients had an AVF, to 65% in 2024. In 2024, 31% of DaVita’s HD patients dialyzed with a catheter (with 23% using tunneled long-term catheters and 8% on temporary catheters). In 2024, 817 DaVita Brazil patients received a kidney transplant, equivalent to ~4.1% of the network’s dialysis population that year (data from internal records). This upward trend in transplant rates represents a major success of care coordination initiatives. 

This 2021–2024 analysis demonstrates that DaVita Brazil outperforms national averages on several key dialysis outcomes. The network’s lower mortality rates highlight effective quality and safety initiatives, keeping outcomes on par with or better than international benchmarks. DaVita’s higher adoption of hemodiafiltration showcases leadership in implementing advanced modalities, which may confer clinical benefits. Importantly, DaVita has significantly increased transplant referrals, contributing to a growing number of patients receiving definitive therapy, an achievement that will improve long-term survival and aligns with ISN goals of expanding transplant access. These strengths can be attributed to structured care programs, continuous quality improvement (QI) processes, and focus on patient-centered outcomes within the network.