Gerenciamento do acesso do doente renal crônico às terapias dialíticas em hospitais públicos: limites e possibilidades.

Abstract

Introduction: Chronic Kidney Disease (CKD) is characterized by heterogeneous alterations in renal structure and function, resulting from multiple causes and risk factors. Often asymptomatic in its early stages, CKD is frequently diagnosed late, which contributes to disease progression and the subsequent need for renal replacement therapies. Objective: The primary objective of this study is to understand the management of access for patients with chronic kidney disease to the Specialized Care Network for dialysis therapies in public hospitals within the Salvador healthcare network. Secondary objectives include identifying the limitations to access and possibilities for improvement, as well as preparing a report with a proactive diagnostic assessment of CKD patient access management to the Specialized Care Network, from the perspective of key stakeholders in Salvador, Bahia. Methodology: This is a descriptive study with a qualitative and exploratory approach, grounded in Bardin’s Content Analysis framework. Fifteen managers involved in regulatory, operational, or planning processes related to access to dialysis beds in public hospitals in Salvador were interviewed. A semi-structured interview guide was used to capture professional perceptions and experiences. The interviews were analyzed using NVivo software. Results: The analysis revealed four main thematic categories: Network Organization, Limitations, Challenges, and Possibilities. Key limitations included insufficient availability of dialysis slots, weak counter-referral flows, late diagnosis, and failures in communication. The main challenges identified were chronic underfunding, shortages of specialized human resources, judicialization of access, and socioeconomic inequalities that place additional strain on Brazil’s Unified Health System (SUS). Possibilities for improvement emerged through feasible proposals, such as modernizing regulation systems through interoperability, strengthening primary health care, expanding therapeutic modalities (including kidney transplantation and peritoneal dialysis), enhancing specialized multidisciplinary care, and improving political coordination. Managers agreed that implementing these measures requires political commitment, adequate funding, and coordinated action among the three levels of government. Final Considerations: The findings indicate that the current situation represents a humanitarian crisis in access to dialysis, with

patients facing imminent risks of death, as well as pronounced social and territorial inequalities. Nevertheless, the study demonstrates the existence of concrete alternatives for network reorganization, supported by national and international evidence. The distinctive contribution of this research lies in incorporating the perspective of managers engaged in practical decision- making, offering a proactive diagnostic approach that integrates scientific rigor, applicability, and social commitment. The study reaffirms that overcoming the dialysis access crisis requires not only technical advancements, but also human sensitivity, political articulation, and sustained public investment. Keywords: Chronic Kidney Disease; Renal Replacement Therapy; Access to Health Services; Health Management; Public Health Policies.