Background Chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to the burden of disease it entails and the difficulty in accessing treatment. LA has a total population of 652 million people living in twenty countries that occupy an area of 19.2 million km2.The LA Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993.This paper summarizes the registry data corresponding to 2019. Methods Participating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP) expressed in US dollars and life expectancy at birth (LEB) corresponding to the year 2019 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB. Results On 31 December 2019 a total of 432 610 patients were in KRT in LA, corresponding to an overall unadjusted prevalence of 866 pmp. In relation with treatment modality, 66.7% of the prevalent patients were treated by HD and 9.3% by PD while 24% of the patients had a living functional graft. 85 224 patients started KRT in LA, representing a total unadjusted incidence rate of 168 pmp. Diabetic nephropathy as a cause of CKD continues to be a relevant percentage (36%) and five countries reported chronic kidney disease of non-traditional cause. Kidney transplant (KT) rate in the region was 22 pmp, varying from countries with rates close to 1 pmp to greater than 60 pmp. Total prevalence of KRT correlated positively with GDP per capita (r2 = 0.6, p<0.01) and LEB (r2 = 0.23, p<0.05), (Figure 3A and B). Overall incidence rate also significantly correlated with GDP (R2: 0.307 p < 0.05). The overall unadjusted mortality rate was 13%. Conclusion Accessibility to KRT is still limited in LA. It is necessary to continue the efforts made by each country and the Latin American Society of Nephrology and Hypertension to guarantee equal access to treatment.

Objective To compare the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Latin America and Europe, as well as to study differences in macroeconomic indicators, demographic and clinical patient characteristics, mortality rates, and causes of death between these two populations. Methods We used data from 20 Latin American and 49 European national and subnational renal registries that had provided data to the Latin American Dialysis and Renal Transplant Registry (RLADTR) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, respectively. The incidence and prevalence of RRT in 2013 were calculated per million population (pmp), overall and by subcategories of age, sex, primary renal disease, and treatment modality. The correlation between gross domestic product and the prevalence of RRT was analyzed using linear regression. Trends in the prevalence of RRT between 2004 and 2013 were assessed using Joinpoint regression analysis. Results In 2013, the overall incidence at day 91 after the onset of RRT was 181 pmp for Latin American countries and 130 pmp for European countries. The overall prevalence was 660 pmp for Latin America and 782 pmp for Europe. In the Latin American countries, the annual increase in the prevalence averaged 4.0% (95% confidence interval (CI): 2.5%-5.6%) from 2004 to 2013, while the European countries showed an average annual increase of 2.2% (95% CI: 2.0%-2.4%) for the same time period. The crude mortality rate was higher in Latin America than in Europe (112 versus 100 deaths per 1 000 patient-years), and cardiovascular disease was the main cause of death in both of those regions. Conclusions There are considerable differences between Latin America and Europe in the epidemiology of RRT for ESRD. Further research is needed to explore the reasons for these differences.

More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increased.

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Chronic Kidney Disease (CKD) has become one of the most important public health problems worldwide. The analysis and understanding of this global/national/regional reality would benefit from the data of the renal registries. The implementation of a CKD registry (including all categories) is difficult to achieve given its high cost. On the other hand, patients with end-stage kidney disease (ESKD) are easily accessible and constitute the subgroup of greater severity. A Kidney Replacement Therapy Registry (KRTR) is defined as a systematic and continuous collection of a population-based dataset of ESKD patients treated by dialysis/kidney transplant. The lack of available data, particularly in emerging economies, leaves information gaps on health care and outcomes in these patients. The heterogeneity/absence of KRTR in some countries is consistent with the inequities in the access to kidney replacement therapy (KRT) all over the world. In 2014, The Pan American Health Organization (PAHO) proposed to achieve at least a prevalence of KRT patients of 700 pmp by 2019 in every Latin American (LA) country. Since then, PAHO and SLANH (Sociedad Latino Americana de Nefrología e Hipertensión) lead courses of training and certification of KRTR in Latin America. The purpose of this manuscript is to provide guidance on how to set-up a new KRTR in countries or regions still lacking one. Advice is provided on the sequence of steps to setup a KRTR, personnel requirements, dataset content and minimum quality indicators required.