Iniquidades raciais na realização de Transplante Renal entre pacientes em terapia renal substitutiva tratados pelo Sistema Único de Saúde no Brasil de 2008 a 2015

Abstract

Chronic kidney disease (CKD) affects 1 in 10 individuals worldwide. This condition is incurable, and treatment in its final stages is performed through Renal Replacement Therapy (RRT), such as hemodialysis, peritoneal dialysis, or kidney transplantation, the latter being the treatment that provides patients with the best quality of life and survival. The main causes of CKD are highly prevalent underlying diseases, often related to living conditions. The circumstances in which individuals are born, grow, and develop are closely linked to health outcomes. In Brazil, the Black population has a history of unequal development due to structural racism, which has resulted in economic and social disadvantages and is reflected in poorer health conditions in this population. The objective of this study was to assess inequities in the access to and waiting time for kidney transplantation by race/skin color within the Brazilian Unified Health System (Sistema Único de Saúde - SUS). This is a retrospective non-concurrent cohort study from 2008 to 2015, based on secondary data of patients aged 18 years or older, of both sexes, undergoing RRT within SUS, selected from the National Individual-Centered Health Database. To determine the waiting time until kidney transplantation, cumulative incidence curves were constructed, and Gray’s test was applied considering a 95% significance level. To identify which covariates, along with race/skin color, influenced the waiting time for transplantation, the Fine-Gray competing risks proportional hazards model (Hazard Ratio - HR) was used, also considering a 95% confidence interval. A total of 199,305 patients were included in the study, the majority male, residing in the Southeast region of Brazil, aged 50 years or older, and identified as White. White patients undergoing RRT were older compared to Black patients. Among the study participants, 12,352 underwent kidney transplantation, most of whom were White and aged up to 59 years. When comparing waiting times for transplantation, Black patients waited longer than White patients to receive the procedure. In the Fine-Gray regression model, Black patients had a 27% lower probability of receiving a kidney transplant compared to White patients. These findings reinforce the existence of racial inequities in access to kidney transplantation in Brazil.