End-Stage Renal Disease and Its Treatment in Latin America in the Twenty-First Century

Abstract

The Latin American Society of Nephrology and Arterial Hypertension's Dialysis and Transplant Registry was chartered in 1991. It collects information on ESRD and its treatment in 20 countries of the region. The prevalence of patients on renal replacement therapy (RRT) increased from 129 pmp in 1992 to 447 pmp in 2004; in 2004, 56% of the patients were on hemodialysis, 23% on peritoneal dialysis, and 21% had a functioning kidney graft. The highest rates of prevalence were reported in Puerto Rico (1027 pmp), Chile (686 pmp), and Uruguay (683 pmp). Hemodialysis was widely used, except in El Salvador, Mexico, Guatemala, Nicaragua, and the Dominican Republic, where peritoneal dialysis predominated. Incidence rate increased from 27.8 pmp to 147 pmp in the same period of observation; the lowest rate was reported in Guatemala (11.4 pmp) and the highest in Puerto Rico (337.4 pmp). Diabetes mellitus was the leading cause of renal failure in incident patients; the highest rates were reported in Puerto Rico (62.2%) and Mexico (60%). Forty-four percent of the incident population were older than 65 years. Access to renal replacement therapy was universal in Argentina, Brazil, Chile, Cuba, Puerto Rico, Uruguay, and Venezuela, while was restricted in other countries. Main causes of death in dialysis were cardiovascular (44%) and infectious disease (26%). The rate of renal transplantation increased from 3.7 pmp in 1987 to 14.5 in 2004; fifty-three percent of the organs came from cadavers. Overall, donation rate was 5.9 pmp. In conclusion, the prevalence and incidence rates have increased over the years, and diabetes mellitus has emerged as the leading cause of kidney disease in the region. Although the rate of kidney transplantation has increased, the number remains insufficient to match the growing demand. The implementation of renal health programs in the region is urgently needed.

Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

“…20 The small In Brazil, men represent the majority (57%) of new patients, a fi nding similar to international studies. 8,9,19 The main cause of CKD identifi ed by our study was hypertension, followed by diabetes, in contrast to other studies performed in countries of America, 6,8,9,19 in which diabetes was identifi ed as the leading cause. The differences observed between the studies may be the result of diffi culties in establishing a precise diagnosis of this disease in Brazil, which can be inferred from the high percentage of indeterminate causes.…”

“…7 The prevalence of 431 pmp found for Brazil is greater than the average of Latin American countries (349 pmp in 2001), 6 but less than in developed countries (700 pmp in Europe and 1403 pmp in the USA) 3 and even those described in countries like Uruguay (809 pmp), Chile (662 pmp) or Argentina (571 pmp). 6 These fi gures suggest that in Brazil a portion of people with ESRD have not been diagnosed or do not have access to health services. 12 Besides this, it is probable that many patients with CKD died from complications of diabetes and hypertension before reaching end stage renal disease.…”

Medicamentos excepcionais para doença renal crônica: gastos e perfil de utilização em Minas Gerais, Brasil

“…Em países como Japão, França, Bélgica, Argentina, Cuba, Porto Rico, Uruguai e Venezuela, os custos de medicamentos para o tratamento da doença renal crônica são totalmente cobertos pelo sistema de saúde, assim como ocorre no Brasil 12,13,14,20 tratamento da doença renal crônica no gasto total com saúde variou de 1,3%, para a França, a 3,7%, para o Japão; os custos dos medicamentos estão incluídos nos custos totais da diálise 12,13,14 . O medicamento utilizado no tratamento da doença renal crônica de maior gasto observado foi a eritropoetina humana recombinante, seja no Brasil, seja em Minas Gerais.…”

“…Na América Latina, a incidência de doença renal crônica é crescente, e os países em que se observam as maiores taxas de incidência são Porto Rico, México, Chile e Uruguai 20 . Nestes, igualmente, o número de unidades de diálise é insuficiente para cobrir a demanda por TRS 20 .…”

“…Nestes, igualmente, o número de unidades de diálise é insuficiente para cobrir a demanda por TRS 20 . Nas nações desenvolvidas, a incidência da doença varia de 97 pessoas por milhão na Austrália a 340 pessoas por milhão nos Estados Unidos 18 .…”