We could cut this cost in half with prevention, not treatment.
Along the triple frontier where Brazil, Argentina, and Paraguay converge, health authorities and patient advocates are gathering in Foz do Iguaçu to confront a quiet epidemic: the slow destruction of kidneys by diabetes, and the slower destruction of lives by inequality. Brazil alone spends billions each year on dialysis for 172,000 patients — most of them poor, most of them treatable earlier — while evidence mounts that simple monitoring technology could have prevented much of the suffering. The II Trinational Forum on Kidney Disease and Diabetes is less a conference than a collective admission that prevention was always possible, and that the failure to pursue it has been, in part, a choice.
- Brazil is on track to spend R$7 billion on kidney disease treatment by 2026 — a cost that advocates argue reflects a system that waits for crisis rather than preventing it.
- A new study of 1,411 diabetic adults reveals that continuous glucose monitoring reduces the odds of kidney damage, blindness, and amputation by 34 to 42 percent — but the technology remains out of reach for those who need it most.
- Nephrologist shortages, medication stockouts, and broken referral pathways mean patients with early kidney disease often have nowhere to turn until the damage is irreversible.
- On June 2nd and 3rd, health ministers, clinicians, and patient advocates from three nations will convene to map the gaps in care protocols and demand structural reforms before the crisis deepens further.
- The forum's central wager is that coordinated regional policy — on screening, education, and technology access — can redirect billions in treatment spending toward prevention, if the political will can be found.
Three countries are meeting in Foz do Iguaçu this June to face a health crisis that has grown in plain sight: diabetes is destroying kidneys across the region, and poverty is determining who survives it.
Brazil has more than 172,000 people on dialysis, 85 percent of them relying on the public health system. Last year the government conducted over 17 million kidney-related procedures at a cost of R$4.3 billion — a figure expected to reach R$7 billion by 2026. Dialysis is not a minor intervention. It means three sessions a week, four hours each, for the rest of a patient's life. It is also, in many cases, preventable.
The II Trinational Forum on Kidney Disease and Diabetes, scheduled for June 2nd and 3rd, will bring together health officials, nephrologists, and patient advocates from Brazil, Argentina, and Paraguay to ask why billions are being spent on kidney failure when far less could have been spent stopping it. A study being released at the forum makes the stakes concrete: among diabetic adults currently using continuous glucose monitoring, 77 percent have no complications at all. Among those who have never used the technology, only 53 percent can say the same. Current users face roughly 38 percent lower odds of kidney disease or nerve damage, and 42 percent lower odds of heart disease or amputation. The technology works. Access to it does not.
Chronic kidney disease affects at least 10 million Brazilians, with diabetes as its leading cause. The disease advances silently — patients feel well while their kidneys fail, and by the time symptoms appear, the damage is often permanent. Terezinha Pinezi of the ADIFI Institute describes a system full of gaps: too few specialists, medications that run out, no reliable bridge between primary care and the nephrology consultations that could slow progression. Vanessa Pirolo of Vozes do Advocacy puts the economic case directly — the R$4 billion spent annually on treatment could shrink substantially with earlier screening and broader access to monitoring tools.
The forum will examine clinical protocols, referral pathways, and the specific structural failures driving the crisis. Officials from Brazil's Health Ministry, state secretaries, and delegations from Argentina and Paraguay will all be present. The event is free and open to diabetes organizations and health professionals across the tri-border region. What the data describes is not an inevitable tragedy but a preventable one — a reckoning that arrives, as reckonings often do, later than it should have.
Three countries are gathering in Foz do Iguaçu this June to confront a problem that has quietly become one of the region's most pressing health crises: the way diabetes destroys kidneys, and the way poverty determines who gets to stop it.
Brazil alone has more than 172,000 people on dialysis right now. The vast majority—85 percent—depend on the public health system. Last year, the government processed over 17 million kidney-related procedures and spent 4.3 billion reais on them. By 2026, that number is expected to climb to 7 billion. These are not small interventions. Dialysis is a lifelong commitment, three times a week, four hours at a time, for most patients. It is expensive. It is exhausting. And it is often preventable.
On June 2nd and 3rd, the II Trinational Forum on Kidney Disease and Diabetes will bring together health officials, nephrologists, and patient advocates from Brazil, Argentina, and Paraguay to ask a question that should have been asked years ago: why are we spending billions treating kidney failure when we could be spending far less preventing it? The forum will examine clinical protocols, care pathways, and the gaps in the system that allow people to slip through undiagnosed until their kidneys are already failing.
A new study being released at the forum reveals something stark about technology and inequality. Researchers surveyed 1,411 Brazilian adults with diabetes and looked at who uses continuous glucose monitoring—a sensor that tracks blood sugar throughout the day. Among people currently using the sensor, 77.3 percent have no diabetes complications at all. Among those who have never used it, only 53.3 percent can say the same. The difference is not subtle. Current users of glucose monitoring technology have roughly 38 percent lower odds of developing kidney disease, eye damage, or nerve damage. They have 42 percent lower odds of heart disease or needing amputation. The technology works. But it is not equally available. Social inequality and access to technology are tightly bound together.
Diabetes is now the leading cause of chronic kidney disease worldwide, and the second leading reason people enter kidney replacement therapy in Brazil. Chronic kidney disease itself affects at least 10 million Brazilians. It often develops silently—people feel fine while their kidneys are quietly failing. By the time symptoms appear, the damage is often irreversible. The disease has multiple causes and multiple risk factors, but diabetes is the engine driving most new cases.
Terezinha Pinezi, president of the ADIFI Institute, frames the challenge plainly: the system has gaps everywhere. There are not enough nephrologists. Medications run out. Specialized consultations are hard to access. People with early kidney disease have nowhere to go for follow-up care—no bridge between primary care and the specialists who could slow the disease's progression. Vanessa Pirolo, president of Vozes do Advocacy, makes the economic argument: the government spends 4 billion reais annually treating kidney disease. That money could be cut dramatically if more people were screened early, if more people with diabetes had access to monitoring technology, if more people knew to get simple blood and urine tests done before their kidneys failed.
The forum will bring together officials from Brazil's Health Ministry, state health secretaries, and representatives from Argentina and Paraguay. They will discuss the Line of Care—the pathway a patient should follow from diagnosis to treatment. They will examine the Clinical Protocol and Therapeutic Guidelines. They will name the specific failures: the shortage of medications, the absence of referral systems that send patients back to primary care, the uneven distribution of specialists across regions. The event is free and open to diabetes organizations and health professionals in the tri-border region.
What emerges from the data and the planning is a picture of a preventable crisis being treated as inevitable. Millions of people are on dialysis because they were never screened. Millions more are at risk because they cannot access the tools that would let them manage their disease. The forum is not a celebration. It is a reckoning.
Citações Notáveis
We need to build a diabetes education program to reduce kidney complications and address gaps in care—medication shortages, specialist availability, and the lack of follow-up systems.— Terezinha Pinezi, president of Instituto ADIFI
The government spends 4 billion reais annually on kidney disease treatment. That could be significantly reduced through greater investment in prevention and early detection.— Vanessa Pirolo, president of Vozes do Advocacy
A Conversa do Hearth Outra perspectiva sobre a história
Why does a forum on kidney disease need three countries at the table?
Because the problem doesn't stop at borders. Diabetes doesn't recognize them. And the solutions—the protocols, the technology, the way you organize care—those work better when you're learning from neighbors facing the same constraints.
The data on glucose monitors is striking. But it also sounds like it's saying: if you're rich enough to afford the technology, you won't get sick.
That's exactly what it's saying. And that's the whole problem. The technology exists. It works. But access follows money, not need. So you have people in the same city, same country, with the same disease, and one group has a 77 percent chance of staying healthy while the other has only a 53 percent chance. The difference is not biology. It's economics.
Four billion reais a year on treatment. That's a lot of money to be spending on something preventable.
It is. And the people running the health system know it. That's why they're having this forum. They're saying: we could redirect some of that money upstream. Screen people earlier. Give them access to monitoring. Catch kidney disease when it's still manageable. But that requires changing how the system works, and that's harder than just continuing to pay for dialysis.
What happens to someone who gets diagnosed late?
They go on dialysis. Three times a week, four hours each time, for the rest of their life. Their kidneys are already too damaged to filter waste. The dialysis machine does that work instead. It's life-saving, but it's also a sentence. You're tied to a machine. You can't travel easily. You're at risk of infections. Your quality of life changes completely. And it costs the system thousands of reais every month, forever.
So the forum is really about trying to prevent that sentence from being handed down in the first place.
Yes. It's about asking: why are we waiting until people are in crisis? Why aren't we screening everyone with diabetes? Why don't they have access to the tools that would let them manage their blood sugar and protect their kidneys? The answers are systemic. Not enough specialists. Not enough money allocated to prevention. No clear pathway for people to get follow-up care. The forum is trying to name those gaps and figure out how to close them.