Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)
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Fecha
2024
Autores
Calice-Silva, Viviane
Neyra, Javier A.
Ferreiro Fuentes, Alejandro
Singer Wallbach Massai, Krissia Kamile
Arruebo, Silvia
Bello, Aminu K
Caskey, Fergus John
Damster, Sandrine
Donner, Jo-Ann
Jha, Vivekanand
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Elsevier
Resumen
Successful management of chronic kidney disease (CKD)
in Latin America (LA) continues to represent a
challenge due to high disease burden and geographic
disparities and difficulties in terms of capacity,
accessibility, equity, and quality of kidney failure care.
Although LA has experienced significant social and
economic progress over the past decades, there are still
important inequities in health care access. Through this
third iteration of the International Society of
Nephrology Global Kidney Health Atlas, the indicators
regarding kidney failure care in LA are updated. Survey
responses were received from 22 of 31 (71%) countries
in LA representing 96.5% of its total population.
Median CKD prevalence was 10.2% (interquartile range:
8.4%–12.3%), median CKD disability-adjusted life year
was 753.4 days (interquartile range: 581.3–1072.5 days),
and median CKD mortality was 5.5% (interquartile
range: 3.2%–6.3%). Regarding dialysis modality,
hemodialysis continued to be the most used therapy,
whereas peritoneal dialysis reached a plateau and
kidney transplantation increased steadily over the past
10 years. In 20 (91%) countries, >50% of people with
kidney failure could access dialysis, and in only 2 (9%)
countries, people who had access to dialysis could
initiate dialysis with peritoneal dialysis. A mix of public
and private systems collectively funded most aspects of
kidney replacement therapy (dialysis and
transplantation) with many people incurring up to 50%
of out-of-pocket costs. Few LA countries had CKD/
kidney replacement therapy registries, and almost no
acute kidney injury registries were reported. There was
large variability in the nature and extent of kidney
failure care in LA mainly related to countries’ funding structures and limited surveillance and management
initiatives.
