Abstract: TH-PO0598
Implementation of an Integrated Inpatient Nephrology Care Pathway Across a Brazilian Multicenter Private Hospital Network, 2019-2025
Session Information
- CKD: From Global Burden to Precision Care - Epidemiology, Demographics, Geographies, and Risk Factors
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Carvalho, Maria Fernanda Camargo, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
- Santos, Marcelo Moreira, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
- Koch Nogueira, Paulo C., Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
Background
Patients hospitalized with acute kidney injury (AKI) or chronic kidney disease (CKD) requiring kidney replacement therapy (KRT) are highly complex, but evidence on standardized inpatient nephrology care pathways in multicenter networks remains scarce in Latin America.
Methods
We conducted a multicenter descriptive implementation study of an integrated inpatient nephrology pathway across 9 Brazilian private hospitals from 2019 to 2025, later expanded to 12 hospitals. The program standardized AKI/CKD protocols, nephrology prescriptions, dialysis materials, nursing processes, multidisciplinary workflows, billing/auditing interfaces, indicators, and technical site visits. Kaplan–Meier estimates assessed 15- and 30-day survival by year; differences were tested with the log-rank test.
Results
By 2025, implementation reached 100% across the 9 original hospitals. In total, 14,721 AKI/CKD hospitalizations requiring KRT were monitored. The program trained 662 professionals, delivered 75 educational activities, and implemented eight clinical guidelines. Operational maturity improved, with better documentation, standardized workflows, and electronic medical record integration. Mortality declined: 30-day cumulative mortality fell from 32.2% to 16.5%, and 15-day mortality from 16.0% to 8.1% between 2019 and 2025 (log-rank p < 0.001; Figure 1).
Conclusion
An integrated inpatient nephrology care pathway was feasible, scalable, and sustainable, strengthening standardization, governance, and operational integration across a Brazilian multicenter network. Mortality declined over time, but causality cannot be inferred. Findings are hypothesis-generating and may reflect changes in case-mix, staffing, critical care, dialysis logistics, electronic records, and institutional learning.