Latin America is a heterogeneous region comprised of 20 countries, former colonies of European countries, in which Latin-derived languages are spoken. According to the Latin American Society of Nephrology and Hypertension/ Sociedad Latino Americana de Nefrologia e Hipertensión (SLANH), the acceptance rate for renal replacement therapy is 103 new patients per million population. In Latin America, hemodialysis is the predominant form of replacement therapy for end-stage renal disease; however, some countries employ peritoneal dialysis (PD) in 30% or more patients. In particular, Mexico is the country with the largest PD utilization in the world, and furthermore, it is estimated that approximately 25% of the world's PD population may be found Latin America. Data concerning clinical practice and long-term outcome of PD in Latin America are scarce, although regional registries are increasing in number and quality. In this review article, we present an overview of the situation of PD in several countries of Latin America, based on the registry of the SLAHN, national registries, and personal communication with PD experts from different countries.

Peritoneal dialysis has a high acceptance rate in Latin America, thus the knowledge concerning complication patterns is of great relevance. This work reviews Latin American data on peritonitis, the most serious complication of peritoneal dialysis. The incidence of peritonitis has been reduced over time, concomitantly with the incorporation of safer exchange systems and the use of prophylactic measurements. Today, rates lower than 1 episode per 24 patient-months are commonly reported. Furthermore, changes in causative organisms have been observed, with predominance of Staphylococcus aureus up through the mid-1990s, as well as increases in coagulase-negative staphylococcus and participation of gram negatives. However, the prevalence of S. aureus is still high, due possibly to climatic conditions and the elevated prevalence of carriers. Resolution rate varies from 55% to 78%, transfer to hemodialysis from 10.9% to 15.4%, and death in 3% to 9.9% of cases. Outcome is worse in S. aureus episodes compared to those with coagulase-negative staphylococcus, despite the higher percentage of oxacillin-resistant strains among the former. In general, despite socioeconomic or climatic conditions, our results are similar to those in developed countries, perhaps as a consequence of technological improvements and/or center expertise.

This paper describes our experience during the first 39 months of the CAPD program at the Miguel Perez Carreno Hospital in Caracas, Venezuela. Forty-eight patients were started on CAPD and treated for a total of 767 patient/months. Mean age was 45.8 years. Average time in the program was 15.9 months. At 39 months 87% of patients were alive and 78% were still on CAPD. The peritonitis rate was one episode per 6.39 pt/month with a probability of peritonitis of 0.70 at 25 months. Incidence of sterile peritonitis was high (41 %). Our patients had a low hospital admission rate (0.5 days per patient month) and a high percentage were rehabilitated (81%). Chronic ambulatory peritoneal dialysis (CAPD) is a widely accepted therapy for end-stage renal disease (ESRD): in Venezuela, approximately 160 patients (37%) of all those under treatment for ESRD receive this form of therapy. The Nephrology Section of the Miguel Perez Carreno Hospital in Caracas manages the largest CAPD program in the country. Here 149 patients are receiving treatment for ESRD by different techniques -hospital hemodialysis, home hemodialysis, intermittent peritoneal dialysis, CAPD and renal transplantation, under the care of five nephrologists, four nephrology residents and 30 nurses. Our CAPD program started in January 1980. This paper, which describes our three years of experience, indicates that CAPD is feasible in a country such as ours which, because of economic problems, is limited in its ability to provide other forms of treatment for ESRD.

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