Latin America is the region with the highest burden of chronic kidney disease (CKD) in terms of disability-adjusted life years and premature deaths. This situation is due in part to many countries struggling to implement early detection and treatment of CKD and kidney failure. There are significant disparities in resources and access, according to the International Society of Nephrology's World Kidney Health Atlas 2023 report on Latin America. Kidney International Supplements It is expected to be presented at the World Congress of Nephrology in 2024.
Magdalena Madero, MD, an internal medicine specialist and head of the nephrology department at the Ignacio Chavez National Cardiology Institute in Mexico City, stressed that the seriousness of the problem means authorities need to recognize the need for early intervention.
“The most important thing is to raise awareness so that kidney disease can be detected early in high-risk populations. We now have medications that can prevent progression and avoid the need for dialysis or transplant, which are the most expensive treatments. Early detection is cost-effective,” Madero said. Medscape Spanish Edition.
Epidemiology and costs
To draft this report, which updates the previous 2019 edition, the authors reviewed the literature and official data, and surveyed leading experts in 22 of the 31 countries in Latin America and the Caribbean, representing 96.5% of the region's population.
The median prevalence of CKD in the region is 10.2% (95% CI, 8.4%-12.3%), higher than the global average of 9.5% (95% CI, 5.9%-11.7%).The most affected countries or territories are Puerto Rico (16.8%), Costa Rica (14.8%), and Mexico (13.8%).
The highest CKD mortality rates are in Mexico, El Salvador and Nicaragua (9.8%). [95% CI, 9.3-10.2]; 10.2% [95% CI, 9.2-10.9]; 11.9% [95% CI, 11.1-12.6]Each).
The median prevalence of treated renal failure in the region was 684 per million population (95% CI, 457-858), lower than the global average of 822.8 per million population. The lowest prevalence in the region was in Nicaragua, and the highest in Puerto Rico.
The median incidence of treated renal failure in the region was 134.5 cases per million population (95% CI, 31-181), lower than the global average of 145.5 cases per million. The lowest incidence was in Nicaragua (33 cases per million), and the highest was in Mexico (526.5 cases per million).
Every country has at least one type of renal replacement therapy in place. According to 2020 data from the Latin American Dialysis and Kidney Transplant Registry of the Latin American Society of Nephrology and Hypertension, 67% of patients with kidney failure were treated with in-center hemodialysis (n = 290,099), 9.3% with peritoneal dialysis (n = 40,450), and 23.6% underwent kidney transplants (n = 102,772). Home hemodialysis, which rents equipment and has “good results in countries such as Canada and the United States,” is virtually nonexistent in Latin America, Madero said.
Despite the Pan American Health Organization promoting home peritoneal dialysis as the most cost-effective dialysis strategy to expand access for patients with end-stage CKD, home peritoneal dialysis is provided to more than 10% of the population requiring renal replacement in only five countries: Guatemala (19.9%), Panama (21.1%), Colombia (40.6%), Mexico (60%) and Nicaragua (73.3%).
Dialysis cost data were available for 15 countries (55%). The median annual cost of hemodialysis ($17,241; 95% CI, $14,275–$25,861) and the median annual cost of peritoneal dialysis ($15,846; 95% CI, $10,173–$19,893) were lower than the global averages of $18,959 and $19,380, respectively. The highest annual costs for hemodialysis and peritoneal dialysis were in Costa Rica ($103,444 and $24,203, respectively), and the lowest were in Brazil ($9,615) for hemodialysis and Mexico ($5,474) for peritoneal dialysis. “In countries like Mexico and Guatemala, the cost of peritoneal dialysis is almost half that of hemodialysis, while in other countries peritoneal dialysis is much more expensive,” Madero said. The fact that Mexico produces the fluid for this dialysis procedure, avoiding import costs, helps explain the situation.
Labor force survey
Most countries did not provide information on public funding of medicines. Only seven of the 22 countries responding to the survey (31.8%) reported that dialysis drugs are publicly funded free of charge, but this proportion doubled when asked about coverage of drugs used in transplants. Only Brazil and Nicaragua publicly cover non-dialysis CKD drugs, but their regional share is 5%, well below the global share (27%).
Only Costa Rica and Puerto Rico have registries for all levels of kidney care: CKD, dialysis, transplantation, and acute kidney injury. Other countries, such as Argentina, Brazil, Chile, Colombia, Paraguay, and Uruguay, have registries for the first three levels (excluding acute kidney injury). Guatemala has a registry only for dialysis and transplantation, and Mexico has a registry only for transplantation.
The median number of nephrologists in Latin America is 12.5 (95% CI, 8.5-25.9) per million population, which is similar to the global average. There are about 10 times as many adult specialists as pediatric specialists. This ratio also varies by country and decreases in middle-income and low-income countries. For example, the ratio is 64.47 in Uruguay, 25.95 in Argentina, 10.45 in Mexico, and 0.44 in Haiti per million population. The regional average for nephrologists in training is 1.4 (95% CI, 0.9-2.7) per million population, which is similar to the global average.
The region saw the highest number of CKD patients treated per nephrologist (54.1) in Mexico (182.3) and the lowest in Uruguay (18.5).
In 95% of the countries in the region that responded to the survey, nephrologists are solely focused on treating patients with kidney failure, with little involvement from other medical professionals. “This result is unfavourable because all the responsibility rests on nephrologists and there are very few of them,” Madero said. “Nurses and other professionals should be empowered to run peritoneal dialysis clinics and have a much greater influence over patients.”
Regarding specialist shortages, transplant surgeons (86%) were reported to be in highest shortage among the 22 countries that responded to the survey, followed by pediatric nephrologists (73%) and nephrologists (68%). Considering the multidisciplinary team, the greatest need was for dietitians, dialysis nurses, renal patient care nurses, nephrology nurses, and dialysis technicians (55%, 59%, 45%, 41%, and 36%, respectively). Of the 17 specialties considered, the countries reporting the greatest shortages were Nicaragua (17) and Paraguay (17), followed by the Cayman Islands, the British Virgin Islands, and Haiti with 16 each. Meanwhile, Brazil reported only a need for transplant surgeons, while Uruguay reported a need for vascular access coordinators and pediatric nephrologists.
“The burden of kidney disease is high in the region and this analysis highlights significant disparities in healthcare capacity, particularly between low-, middle- and high-income countries in the region. Fragmented funding structures and prohibitive costs for individuals, as well as a shortage of specialized healthcare workers, are major challenges, particularly with regard to renal replacement therapy. Cost-effective dialysis therapies such as peritoneal dialysis remain underutilized, and CKD management for those who choose not to undergo or cannot access renal replacement therapy is also poor, further affecting healthcare capacity for patients with kidney failure,” the researchers conclude in their report.
Madero disclosed that he had received compensation or grants from AstraZeneca, Bayer, Boehringer Ingelheim and the Kidney Research Institute. The other authors declared conflicts of interest in their paper.
This story is Medscape Spanish version As part of our process, we use multiple editing tools, including AI, and a human editor reviewed this content before publishing.
