Auditing Renal Replacement Therapy: A Temporal Analysis of Services in the Southeastern Region.
health audit; renal replacement therapy; Brazilian Unified Health System; monitoring; governance.
Chronic Kidney Disease is a highly complex health challenge for public health, requiring robust funding from the Unified Health System for Renal Replacement Therapy. In this scenario, the SUS audit acts as an indispensable governance mechanism to ensure the efficiency and quality of public spending. The objective of this study was to analyze the evolution, standards and limitations of audit instruments applied to TRS in the Southeast Region, between 2016 and 2024. It was an exploratory and descriptive research, with a quantitative approach, carried out through comparative documentary analysis of audit protocols, examination of reports extracted from the SISAUD system and cross-referencing with production data from the Ambulatory Information System. The results revealed weaknesses in the control cycle: a low immediate resolution of non-conformities identified in the preliminary phase was identified, with zero or insignificant compliance rates in state and municipal administrations. The longitudinal analysis showed the persistence of structural and care failures in the same units over time, indicating the low effectiveness of recommendations without systematic monitoring. Additionally, the analysis of the selection criteria demonstrated a bias towards concentration in high production volume. Although this criterion captures most of the financial volume in smaller networks, it generates distortions in states with dense networks: in São Paulo, the criterion selected only 7% of providers, excluding 93% of the care network and 85% of auditable resources. There was also a crystallization of the list of auditees, where a restricted group of providers remained at the top of the selection for more than 88% of the period in states such as Minas Gerais and Espírito Santo. It is concluded that, despite capturing the financial impact, the current model limits the scope of the audit and lacks continuous monitoring mechanisms, requiring the review of selection criteria to consider regional heterogeneities and the institutionalization of monitoring recommendations to ensure the effectiveness of the audit in the SUS.