title: The Challenge of Providing Renal Replacement Therapy in Developing Countries: The Latin American Perspective.
abstract: The costs of health care place developing countries under enormous economic pressure. Latin America is a region characterized by wide ethnic and per capita gross domestic product variations among different countries. Chronic kidney failure prevalence and incidence, as well as provision of renal replacement therapy (RRT), have increased in all Latin American countries over the last 20 years. From an ethical point of view, life-sustaining therapies such as RRT should be available to all patients with chronic kidney disease who might benefit. However, even among Latin American countries with similar per capita incomes and health care expenditures, only some have been able to achieve universal access to RRT. This indicates that it is not just a problem of wealth or distribution of scarce health care resources, but one of social justice. Strategies to increase the availability of RRT and renal palliative-supportive care, as well as implementation of interventions to prevent chronic kidney disease development and progression, are needed in Latin America and other developing countries.
authors.affiliation: Universidad Panamericana School of Medicine, Mexico City, Mexico. Electronic address: gobrador@up.edu.mx.
authors.forename: Gregorio T
authors.initials: GT
authors.lastname: Obrador
authors.affiliation: Universidad Panamericana School of Medicine, Mexico City, Mexico; Universidad Panamericana School of Nursing, Mexico City, Mexico.
authors.forename: Ximena
authors.initials: X
authors.lastname: Rubilar
authors.affiliation: Universidad Panamericana Interdisciplinary Center for Bioethics, Mexico City, Mexico.
authors.forename: Evandro
authors.initials: E
authors.lastname: Agazzi
authors.affiliation: Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico.
authors.forename: Janette
authors.initials: J
authors.lastname: Estefan
mesh_terms: D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D003906:Developing Countries; D015276:Health Care Rationing / Q000458:organization & administration / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000941:ethics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D007843:Latin America / Q000453:epidemiology; D015995:Prevalence; D017582:Renal Replacement Therapy / Q000941:ethics / Q000379:methods / Q000706:statistics & numerical data
keywords: Latin America; Renal replacement therapy (RRT); challenges; chronic kidney disease; developing countries; end-stage renal disease (ESRD); health care expenditures; health disparities; medical ethics