# Incidence, Demographics, and Service Utilization of Patients Referred for Renal Replacement Therapy at the Instituto Mexicano del Seguro Social (IMSS) Michoacán: A Retrospective Analysis

## TL;DR

This study analyzes kidney disease treatment trends in Michoacán, Mexico, finding rising dialysis referrals and regional disparities in care.

## Contribution

The study identifies regional variations in RRT incidence and service utilization within IMSS Michoacán, highlighting the need for infrastructure improvements.

## Key findings

- RRT referral rates increased over time, with a 2021 state incidence of 28.42 per 100,000 population.
- Patients in Zitácuaro and the region of interest were significantly younger at dialysis initiation.
- HD service provision increased over time, but access inequalities persist across regions.

## Abstract

Background: Chronic kidney disease (CKD) is a health condition with high tangible and intangible implications for patients, health systems, and society in Mexico. This study aims to analyze the incidence, demographics, and service utilization of patients referred for renal replacement therapy (RRT) involving peritoneal dialysis (PD) or hemodialysis (HD) in Care units of the Instituto Mexicano del Seguro Social (IMSS) in the state of Michoacán, Mexico.

Methods: A database from IMSS Michoacán containing information from January 2007 to September 2023 was analyzed. Special analyses were performed by subdelegations of adscription of the patients and according to a "region of interest" comprising three municipalities in eastern Michoacán (Zinapecuaro, Hidalgo, and Maravatío). This analysis included incidence rates of patient referrals, mean age at dialysis initiation, and percentages of service provision.

Results: An increasing trend in the incidence of cases referred for RRT was identified. In 2021, the state incidence rate of new cases referred for RRT was 28.42 cases per 100,000 population. However, this rate was markedly higher in the subdelegation of Zitácuaro and the region of interest. The analysis of patients' demographic characteristics showed that the majority were male (n=1494; 60.6%), with a global mean age at dialysis initiation of 50.3 (±17.00 SD) years. However, patients from the subdelegation of Zitácuaro and the region of interest were identified to be significantly younger than those from other municipalities. The analysis of RRT service provision showed a trend over time towards a higher proportion of HD services, with some inequalities in access to HD services.

Conclusions: There is an increasing trend in RRT referrals at IMSS Michoacán. A more significant issue in the incidence of RRT referrals and the mean age at dialysis initiation was identified for a particular subdelegation of adscription and region of interest of the IMSS Michoacán. Moreover, the need to strengthen HD service infrastructure is identified to improve accessibility for insured patients living in various municipalities in Michoacán, Mexico.