Brazilian Dialysis Survey from 1999 to 2024: Trends in Dialysis Modalities and Funding.

For 25 years, the Brazilian Society of Nephrology has systematically monitored chronic dialysis care through the Brazilian Dialysis Survey, offering a unique perspective on the evolution of dialysis practices and access to treatment in a large and diverse middle-income country. Analysis of data from 1999 to 2024 reveals that hemodialysis has remained the dominant modality, representing on average 92% of treatments, while peritoneal dialysis (PD) accounted for only 8% and showed a steady decline. Regional differences have been marked: the Northeast consistently reported the lowest rates of PD, while the South maintained above-average use. Funding sources also reflect broader structural dynamics in the health system. The Unified Health System (Sistema Único de Saúde) has been the backbone of dialysis provision, covering 83% of patients over the period. Yet, the role of private health insurance has expanded, with coverage increasing from 12% in 2006-2009 to 20% in 2019-2024. Interestingly, regional comparisons show contrasting patterns, with private insurance supporting a disproportionately high share of dialysis in the North compared with the general population, while in the Southeast, the opposite scenario was observed. Taken together, these findings illustrate a landscape shaped by declining use of PD, heavy reliance on public financing, and persistent regional inequities. Beyond documenting numbers, the Brazilian Dialysis Survey highlights the need for policies that promote equity, strengthen the role of PD, and ensure sustainable access to KRTs for all Brazilians.