Recommendations of the Brazilian Society of Nephrology for regulating access to outpatient dialysis in the Brazilian Unified Health System

The increase in chronic kidney disease prevalence and its risk factors have pressured universal health systems to expand the supply of kidney replacement therapy (KRT - hemodialysis, peritoneal dialysis and kidney transplantation). Particularly in low- and middle-income countries and those undergoing a fast epidemiological and demographic transition, the access to nephrology consultations and multidisciplinary care is limited, and the majority of patients start KRT in an unplanned manner or during emergency hospitalization. Even patients with adequate pre-dialysis care and elective requests for KRT are at risk of clinical decompensation and requiring hospitalization to start emergency dialysis; this risk increases the longer the delay in starting KRT. In both cases, the patient's access to an outpatient dialysis unit must be timely and the transition of care safe. There are Brazilian and international guidelines for patients who are prevalent on dialysis. However, there are no clear recommendations for regulating access to the start of outpatient KRT, which often leads to divergent opinions among healthcare professionals and contributes to the inefficiency of the regulatory process. This document aims to: (1) list the main challenges in the daily practice of the regulatory professionals in the Brazilian Unified Health System; (2) present recommendations from the Brazilian Society of Nephrology based on scientific evidence and available legislation.