Non-dialysis chronic kidney disease: invisibility and neglect in Primary Health Care

Abstract

Objective: To assess the institutional capacity of primary health care (PHC) for managing non-dialytic chronic kidney disease (ND-CKD) in a municipality of Minas Gerais, Brazil.Method: A descriptive cross-sectional study conducted between May and August 2024. The study population comprised municipal PHC managers as well as physicians and/or nurses providing primary health care services. The validated Portuguese version of the Assessment of Chronic Illness Care (ACIC) instrument was used to evaluate PHC capacity in delivering care to individuals with ND-CKD, employing a Likert scale scored from 0 to 11 points. Descriptive data analysis was performed to characterize the study population and interpret the ACIC results according to the instrument's seven dimensions.Results: The study included representatives from 100% of the PHC units in the analyzed municipality (43 units), totaling 67 participants: 27 (40.3%) physicians, 37 (55.2%) nurses, and the three principal managers. The ACIC revealed a low overall score of 2.8/11 regarding PHC's capacity to assist individuals with renal impairment. Specifically, the lowest scores were observed in the following dimensions: community involvement (2.0/11), clinical information systems (2.0/11), and integration of components of the Chronic Care Model (CCM) (2.0/11).Conclusions: This study identified structural and organizational deficiencies in PHC for managing ND-CKD, highlighting non-compliance with the fundamental principles of Brazil's Unified Health System (UHS) and underscoring the urgent need for investments in professional training and adequate infrastructure to ensure the right to renal health protection.