Recommendations of the Brazilian Society of Nephrology for the management of chronic kidney disease in primary health care.

Brazil has been undergoing rapid epidemiological and demographic transition and faces major challenges in addressing chronic noncommunicable diseases. Among these, chronic kidney disease (CKD) stands out, given its growing prevalence and contribution to 3-7% of healthcare spending in many countries. CKD is considered one of the diseases with the greatest potential for the application of preventive measures, as it has common risk factors, low-cost and widely available diagnostic tests, a known natural history, feasible treatment, and proven cost-effectiveness of interventions. Despite many difficulties, Brazil is internationally recognized for having one of the most robust and inclusive public health systems in the world (the Unified Health System-SUS, in Portuguese). One of the reasons for this recognition is the comprehensiveness and multidisciplinary nature of its primary health care (PHC). Although Brazilian and international guidelines have been published and updated for more than two decades, recent studies continue to show gaps in the implementation of the care pathway for people with CKD in Brazil. The objective of this document was to develop practical recommendations to help PHC managers include CKD in their work routine, considering current guidelines, Brazilian laws, financial and structural resources, and the characteristics of the SUS.