Status and trends in chronic kidney disease and renal replacement therapy in the Russian Federation: 2024 Report. Annual monitoring by the Center for Excellence in Medical Care in Nephrology at Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation

Objective: to establish and conduct annual monitoring of the status and development trends in nephrology care across the federal subjects of the Russian Federation for the year 2024. Materials and methods. A comprehensive set of indicators was developed, and a structured survey was administered among leading freelance nephrology specialists across the regions. The collected data were systematically analyzed. Results. In 2024, the Russian Federation operated 706 hemodialysis (HD) centers and 49 kidney transplant (KT) centers. A total of 73,483 patients were receiving renal replacement therapy (RRT), of whom 76.6% were on HD, 2.7% on peritoneal dialysis (PD), and 20.6% were being monitored with a functioning kidney transplant. During the year, 1,943 KTs were performed across 49 centers in 38 regions. The overall RRT availability in the Russian Federation was 503.2 patients per million population (pmp), with HD at 385.7 pmp, PD at 13.7 pmp, and KT at 103.8 pmp. Among patients receiving HD in 2024, 81.9% were treated via arteriovenous fistula, 12.1% through permanent central venous catheter, 3.6% via temporary catheter, and 2.4% using vascular prostheses. In 2024, the Russian Federation had 537 nephrology outpatient offices, staffed by 690 physicians providing specialized care. The ratio of outpatient nephrologists to the population was 0.24 per 50,000, significantly below the recommended standard for medical personnel. Inpatient care for patients with pre-dialysis stages of chronic kidney disease (CKD) was delivered through 263 departments, comprising a total of 5,039 beds (equivalent to 0.35 beds per 10,000 population). Morphological evaluation of kidney biopsies – an important indicator of inpatient nephrological care – was independently conducted in 38 regions. Kidney biopsies were performed in 2.5% of patients hospitalized in inpatient facilities, translating to an average of 32.8 biopsies per million population. Conclusion. An annual monitoring framework has been successfully developed, with active collaboration established across regional centers, enabling the collection of up-to-date data on nephrological care in the Russian Federation for 2024. There is no current shortage of dialysis facilities, and a significant proportion of patients receive RRT via HD, an approach that places considerable financial burden on the national healthcare system. The high proportion of working-age individuals (62.4%) among HD patients underscores the substantial socio-economic impact of CKD and its treatment on both the state and society. Although the number of KTs continues to rise annually, current transplant volumes remain insufficient to fully meet demand and only partially offset the growing costs associated with RRT. Expanding the use of PD, particularly in sparsely populated regions, may offer advantages over HD. Nonetheless, KT remains the optimal treatment modality for patients with end-stage CKD, supporting the need to further expand transplant infrastructure and increase access to this intervention. The continuation of annual monitoring across all stages of CKD will allow for data-driven improvements in care delivery, incorporating emerging recommendations and regional insights.

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