Prevalence of clinically validated primary causes of end-stage renal disease (ESRD) in a State Capital in Northeastern Brazil

Knowledge of validated primary causes of end-stage renal disease (ESRD) is extremely relevant in the realm of public health. The literature lacks validated studies on the primary causes of ESRD. The aim of this study was to estimate the prevalence of the causes of ESRD in a State Capital in Northeastern Brazil. This cross-sectional study was based on the analysis of medical records of patients on hemodialysis at five specialized centers in Fortaleza, CE, Brazil. Deaths and patients referred to other centers outside Fortaleza were excluded from the study. The data of 830 patients were initially collected, but 818 remained enrolled after the exclusion criteria were applied, the equivalent to 48% of the patents on dialysis in the city. 61.1% of the patients were males. Twenty-two percent of all enrolled individuals were aged 60-69 years. Patient mean age was 55.7 ± 16 years. The most common validated cause of ESRD was unknown (35.3%), followed by diabetes mellitus (26.4%), adult polycystic kidney disease (6.2%), graft failure (6.2%), obstructive uropathy (5.7%), and primary glomerulonephritis (5.3%). Before validation, primary hypertension was the most frequent cause of chronic kidney disease (22.9%), decreased to 3.8% after validation. The data contradicted national studies reporting primary hypertension as the main cause of chronic kidney disease (CKD). A high rate of unknown causes and categorization bias were observed mainly in relation to primary hypertension as a cause of CKD, which affects the overall prevalence of causes of ESRD in patients on dialysis.