Abstract: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 Replac… Show more
“…During 2013 the Pan-American Health Organization (PAHO) developed a strategic plan called ‘In favor of health: sustainable development and equity’ that proposed to increase access to interventions to prevent and control the noncommunicable diseases and their risk factors. In collaboration with the SLANH, which is a non-governmental organization collaborating with the PAHO since 2015, the goal proposed was to achieve universal coverage of KRT and a prevalence rate of at least 700 pmp by 2019 [ 16 ]. In order to make this goal feasible, the plan also proposed to increase the use of PD as a cost-effective KRT modality (20% use was suggested) and to reach a rate of 20 nephrologists pmp to provide adequate care for patients with CKD.…”
Section: Discussionmentioning
confidence: 99%
“…Currently the LADRTR is composed of an executive board and delegates from each of the nephrology societies from the 20 countries that are members of the Latin American Society of Nephrology and Hypertension (SLANH). By 2019, eight countries were classified as registry category 1, meaning that there is not yet a basic type of dialysis and/or kidney transplant systematic registry [ 16 ]. Two countries were category 5, meaning that the registration of dialysis and transplantation is national in scope, with >90% of the patients registered.…”
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.
“…During 2013 the Pan-American Health Organization (PAHO) developed a strategic plan called ‘In favor of health: sustainable development and equity’ that proposed to increase access to interventions to prevent and control the noncommunicable diseases and their risk factors. In collaboration with the SLANH, which is a non-governmental organization collaborating with the PAHO since 2015, the goal proposed was to achieve universal coverage of KRT and a prevalence rate of at least 700 pmp by 2019 [ 16 ]. In order to make this goal feasible, the plan also proposed to increase the use of PD as a cost-effective KRT modality (20% use was suggested) and to reach a rate of 20 nephrologists pmp to provide adequate care for patients with CKD.…”
Section: Discussionmentioning
confidence: 99%
“…Currently the LADRTR is composed of an executive board and delegates from each of the nephrology societies from the 20 countries that are members of the Latin American Society of Nephrology and Hypertension (SLANH). By 2019, eight countries were classified as registry category 1, meaning that there is not yet a basic type of dialysis and/or kidney transplant systematic registry [ 16 ]. Two countries were category 5, meaning that the registration of dialysis and transplantation is national in scope, with >90% of the patients registered.…”
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.
“…En el año 2020, la mortalidad no ajustada fue de 16.6/100 pac-año, lo que significa un descenso del 2% respecto al año 2019 (Tabla 3). En Latinoamérica (LA), en 2019 la mortalidad promedio de la región fue 13.0/100 pac-año, con una variabilidad que va desde 4/100 pac-año en Nicaragua a 25/100 pac-año en Honduras 10 . A su vez, la mortalidad bruta de los pacientes en DC en EE.UU.…”
En Uruguay, el tratamiento de diálisis crónica se expandió a partir de 1980 gracias a la creación del Fondo Nacional de Recursos, entidad que financia los procedimientos diagnósticos y terapéuticos de alto costo. El Registro Uruguayo de Diálisis (RUD) es un registro obligatorio que incluye la información de todos los pacientes que reciben tratamiento de diálisis crónica en el país. El objetivo de este trabajo es comunicar la información recopilada entre los años 1981 y 2020, con especial énfasis en las condiciones de ingreso a diálisis, los resultados del tratamiento y la evolución de la mortalidad. En este periodo observamos un aumento sostenido de la incidencia y la prevalencia de pacientes en diálisis crónica que llegó en el año 2020 a 184 y 820 pmp, respectivamente. Los pacientes en la modalidad de diálisis peritoneal no superaron en ningún momento el 10% de los pacientes prevalentes en diálisis crónica. La edad de los pacientes al ingreso pasó de ser 44.3 ± 13.5 años en 1981 a 62.2 ± 17.1 años en el año 2020, en tanto que los mayores de 65 años de edad aumentaron del 3.0 al 52.4% al final del periodo analizado. La mortalidad bruta aumentó de 14.8/100 pac-año en 1993 a 17.0/100 pac-año en 2019 y 2020, pero no se observaron cambios significativos en el análisis ajustado a estándar. La principal causa de muerte fue la cardiovascular, oscilando entre el 27 y el 51% de la mortalidad total. En segundo lugar, la causa infecciosa (14 a 23%), seguida por la suspensión del tratamiento (1 a 18%) y las enfermedades neoplásicas (4 a 12%). Los datos recabados y analizados por el RUD han contribuido y constituyen un insumo de valor para el proceso de mejora continua, con el objetivo de brindar atención integral de excelencia.
“…Un aspecto relevante para destacar es que buena parte de la información disponible está basada en datos obtenidos de registros de ERC y/o de tratamiento renal sustitutivo (TRS), que se han desarrollado en los países de la región de manera dispar a lo largo del tiempo, pero con un impulso destacado en la última década 2 .…”
Section: Diagnóstico De Situación De La Nefrología Latinoamericanaunclassified
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