The health system in Chile: the nephrologist perspective

Ardiles, Leopoldo; Poblete, Hugo; Ortiz, Mauricio; Elgueta, Susana; Cusumano, Ana María; Vukusich, Antonio; Mezzano, Sergio

doi:10.5301/jn.2011.6371

Cited by 7 publications

(3 citation statements)

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“…If the original data were to prove inaccurate, many cases of CKD in the Nicaraguan population might be missed. Nicaragua would struggle to address this serious problem, as more developed Latin American nations fight to contain the costs related to caring for patients with CKD and its sequelae (20). If this data were accurate, it would argue for a more localized epidemic with a separate etiology.…”

Section: Introductionmentioning

confidence: 99%

Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village

Laux

Bert²,

Ruiz³

et al. 2011

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Background Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD’s prevalence in regions at higher altitudes. Methods A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30–300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index. Results Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02). Conclusions The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.

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Section: Introductionmentioning

confidence: 99%

Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village

Laux

Bert²,

Ruiz³

et al. 2011

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“…The growing burden of CKD in children where the majority presents in ESRD has motivated some low income countries to initiate a renal care program, for example, Sudan (27). Although the health spending is low, <10% in most of the countries, transplantation is state funded in some countries with higher GDPs, for example, Malaysia, Kuwait, Chile and Saudi Arabia (21,(35)(36)(37). The percentage of children getting transplant thus varies from 3.9% in Sudan to 75% in Kuwait and the overall transplant rates in children are <15/year in a majority of the countries (Table 1).…”

Section: Economic Issuesmentioning

confidence: 99%

Pediatric Kidney Transplantation in the Developing World: Challenges and Solutions

Rizvi

Sultan

Zafar

et al. 2013

American Journal of Transplantation

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The prevalence of pediatric RRT and transplantation are low in developing countries, 6-12 and <1 to 5 per million child population (pmcp), respectively. This is due to low GDP/capita of <$10 000, government expenditure on health of <2.6-9% of GDP and paucity of facilities. The reported incidence of pediatric CKD and ESRD is <1.0-8 and 3.4-35 pmcp, respectively. RRT and transplantation are offered mostly in private centers in cities where HD costs $20-100/session and transplants $10 000-20 000. High costs and long distance to centers results in treatment refusal in up to 35% of the cases. In this backdrop 75-85% of children with ESRD are disfranchised from RRT and transplantation. Our center initiated an integrated dialysis-transplant program funded by a community-government partnership where RRT and transplantation was provided ''free of cost'' with life long follow-up and medication. Access to free RRT at doorsteps and transplantation lead to societal acceptance of transplantation as the therapy of choice for ESRD. This enabled us to perform 475 pediatric transplants in 25 years with 1-and 5-year graft survival of 96% and 81%, respectively. Our model shows that pediatric transplantation is possible in developing countries when freely available and accessible to all who need it in the public sector.

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“…avukusich@davila.cl E n las últimas décadas se ha producido un explosivo crecimiento de los pacientes que acceden al tratamiento de la enfermedad renal crónica terminal (ERCT), particularmente hemodiálisis crónica (HDC). Desde que se dispuso de cobertura financiera, en la década de 1980-89, hemos pasado, en números absolutos, de 185 pacientes a más de 17.000 en la actualidad, con la mayor cantidad de pacientes en HDC por millón de habitantes de América Latina 1,2 . Esto ha significado un enorme desafío profesional, ya que los centros de hemodiálisis crónica (CHDC) superan al número de especialistas en nefrología y las enfermeras/os han debido formarse, aceleradamente, para cubrir la demanda de atención.…”

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Problemas ético-clínicos en hemodiálisis crónica: percepción de médicos y enfermeras

et al. 2016

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The health system in Chile: the nephrologist perspective

Cited by 7 publications

References 0 publications

Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village

Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village

Pediatric Kidney Transplantation in the Developing World: Challenges and Solutions

Problemas ético-clínicos en hemodiálisis crónica: percepción de médicos y enfermeras

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