End-stage renal disease and its treatment in Latin America in the twenty-first century.
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.
Cusumano
Ana
A
The Latin American Society of Nephrology and Arterial Hypertension's Dialysis and Transplant Registry Committee, Buenos Aires, Argentina.
Garcia-Garcia
Guillermo
G
Di Gioia
Cristina
C
Hermida
Osvaldo
O
Lavorato
Carlos
C
Carreño
Cesar Agost
CA
Torrico
Maria Placida Garron
MP
Batista
Paulo Benigno Pena
PB
Romão
João Egídio
JE
Badal
Hugo Poblete
HP
Miranda
Susana Elgueta
SE
Gomez
Rafael
R
Calderon
Manuel Cerdas
MC
Sanchez
Sergio Herra
SH
Lopez
Miguel Almaguer
MA
Moscoso
Julio
J
Merino
Ricardo Leiva
RL
Polo
Jose Vicente Sánchez
JV
Lopez
Alirio
A
Romero
Norman Jiron
NJ
Garcia
Ramiro
R
Acosta
Blanca V Franco
BV
Lopez
Augusto Saavedra
AS
Delpin
Eduardo Santiago
ES
Mena
Emilio
E
González
Carlota
C
Milanés
Carmen Luisa
CL
Acchiardo
Sergio
S
D000368:Aged; D017691:Caribbean Region / Q000453:epidemiology; D002489:Central America / Q000453:epidemiology; D006297:Health Services Accessibility; D006436:Hemodialysis Units, Hospital; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000639:trends; D007843:Latin America / Q000453:epidemiology; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000639:trends; D015995:Prevalence; D012042:Registries; D006435:Renal Dialysis / Q000639:trends; D017582:Renal Replacement Therapy / Q000639:trends*; D013020:South America / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome