title: Renal replacement therapy in Latin American end-stage renal disease.
abstract: The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r20.86; P < 0.05) and life expectancy at birth (r20.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r20.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit.
authors.affiliation: Sociedad Latinoamericana de Nefrología e Hipertensión , Executive Board of the Latin American Dialysis and Transplant Registry (LADTR) , Buenos Aires , Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Rosa-Diez
authors.affiliation: Sociedad Latinoamericana de Nefrología e Hipertensión , Executive Board of the Latin American Dialysis and Transplant Registry (LADTR) , Buenos Aires , Argentina ; Sociedad Uruguaya de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Uruguay , Montevideo , Uruguay.
authors.forename: Maria
authors.initials: M
authors.lastname: Gonzalez-Bedat
authors.affiliation: Sociedad Latinoamericana de Nefrología e Hipertensión , Executive Board of the Latin American Dialysis and Transplant Registry (LADTR) , Buenos Aires , Argentina.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
authors.affiliation: Sociedad Argentina de Nefrología , Delegates to the LADTR from National Societies of Nephrology from Argentina , Santa Fe , Argentina.
authors.forename: Sergio
authors.initials: S
authors.lastname: Marinovich
authors.affiliation: Sociedad Boliviana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Bolivia , La Paz , Bolivia.
authors.forename: Sdenka
authors.initials: S
authors.lastname: Fernandez
authors.affiliation: Sociedade Brasileira Nefrologia, Delegates to the LADTR from National Societies of Nephrology, Niterói, Brazil.
authors.forename: Jocemir
authors.initials: J
authors.lastname: Lugon
authors.affiliation: Sociedad Chilena de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Chile , Santiago , Chile.
authors.forename: Hugo
authors.initials: H
authors.lastname: Poblete-Badal
authors.affiliation: Sociedad Chilena de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Chile , Santiago , Chile.
authors.forename: Susana
authors.initials: S
authors.lastname: Elgueta-Miranda
authors.affiliation: Sociedad Colombiana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Colombia , Bogota , Colombia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Gomez
authors.affiliation: Sociedad Costarricense de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Costa Rica , San Jose de Costa Rica , Costa Rica.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cerdas-Calderon
authors.affiliation: Sociedad Cubana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Cuba , La Habana , Cuba.
authors.forename: Miguel
authors.initials: M
authors.lastname: Almaguer-Lopez
authors.affiliation: Sociedad Ecuatoriana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Ecuador , Quito , Ecuador.
authors.forename: Nelly
authors.initials: N
authors.lastname: Freire
authors.affiliation: Sociedad Salvadoreña de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from El Salvador , San Salvador , El Salvador.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Leiva-Merino
authors.affiliation: Sociedad Hondureña de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Honduras , Tegucigalpa , Honduras.
authors.forename: Gaspar
authors.initials: G
authors.lastname: Rodriguez
authors.affiliation: Sociedad Guatemalteca de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Guatemala , Guatemala , Guatemala.
authors.forename: Jorge
authors.initials: J
authors.lastname: Luna-Guerra
authors.affiliation: Sociedad Mexicana de Nefrología , Delegates to the LADTR from National Societies of Nephrology from Mexico , Mexico , Mexico.
authors.forename: Tomasso
authors.initials: T
authors.lastname: Bochicchio
authors.affiliation: Sociedad Mexicana de Nefrología , Delegates to the LADTR from National Societies of Nephrology from Mexico , Mexico , Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Garcia
authors.affiliation: Sociedad Nicaraguense de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Nicaragua , Managua , Nicaragua.
authors.forename: Nuria
authors.initials: N
authors.lastname: Cano
authors.affiliation: Sociedad Nicaraguense de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Nicaragua , Managua , Nicaragua.
authors.forename: Norman
authors.initials: N
authors.lastname: Iron
authors.affiliation: Sociedad Panameña de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Panama , Panama , Panama.
authors.forename: Cesar
authors.initials: C
authors.lastname: Cuero
authors.affiliation: Sociedad Paraguaya de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Paraguay , Asuncion , Paraguay.
authors.forename: Dario
authors.initials: D
authors.lastname: Cuevas
authors.affiliation: Sociedad Peruana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Peru , Lima , Peru.
authors.forename: Carlos
authors.initials: C
authors.lastname: Tapia
authors.affiliation: Sociedad Portorriqueña de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Puerto Rico , San Juan , Puerto Rico.
authors.forename: Jose
authors.initials: J
authors.lastname: Cangiano
authors.affiliation: Sociedad Dominicana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Republica Dominicana , Santo Domingo , Dominican Republic.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rodriguez
authors.affiliation: Sociedad Venezolana de Nefrologia , Delegates to the LADTR from National Societies of Nephrology from Venezuela , Caracas , Venezuela.
authors.forename: Haydee
authors.initials: H
authors.lastname: Gonzalez
authors.affiliation: Sociedad Latinoamericana y Caribeña de Trasplante , Delegates to the LADTR from National Societies of Nephrology , Porto Allegre , Brazil.
authors.forename: Valter
authors.initials: V
authors.lastname: Duro-Garcia
keywords: Latin America; chronic renal failure; hemodialysis; kidney transplantation; peritoneal dialysis