[Frequency of diagnosis and clinic presentation of glomerulopathies in Uruguay]. / Frecuencia de diagnóstico y de presentación clínica de las glomerulopatías en el Uruguay.

UNLABELLED: The Uruguayan Registry of Glomerulopathies began its activity in 1974 and since 1985 is a national registry. The aim of this report is to analyze the incidence and the variations in frequencies of the histological diagnosis and clinical presentation during the 1980-2003 period. PATIENTS AND METHODS: From the 2,058 patients with renal biopsy in the whole period, we analyzed the histological diagnosis and the following data has been collected when the patients were registered: age, gender, clinical syndrome, proteinuria, hematuria, serum creatinine, blood pressure and time from the first symptom. Four periods of registry entry were considered: 1980-1989, 1990-1994, 1995-1999 and 2000-2003. Chi-square and Student test for independent samples were used to evaluate the differences among the variables frequencies in the four periods. RESULTS: The incidence of registered glomerulopathies per million population (pmp) increased from 13 (1980-1989) to 43 (2000-2003). In the 2000-2003 period, the incidences pmp were: primary glomerulopathy (PG), 25.3 and secondary glomerulopathy, 14.2. The highest incidences pmp were: focal and segmental glomeruloesclerosis (FSGS) 6.4; vasculitis 5.4; lupus nephritis 4.6; minimal change disease (MCD) 4.6; IgA nephropathy (IgAN) 4.5; and membranous nephropathy (MN) 4.0. The most frequent PG were the FSGS (29.3%) and the MCID (19.6%). The FSGS frequency decreased from 36.3% in 1995-1999 to 19.1% in 2000-2003. The IgAN frequency increased from 5.2% in 1980-1989 to 17.5% in 2000-2003. Nephrotic syndrome was the most frequent clinical presentation; its frequency was over 30% in the four periods. Asymptomatic urinary abnormality frequency increased from 14.0% in 1980-1989 to 22.7% in 2000-2003. The frequency of serum creatinine under 1.5 mg/dl, increased from 42.2% in 1980-1989 to 67.2% in 2000-2003 (p = 0.001). The frequency of serum creatinine over 6.0 mg/dl, decreased from 19.3% in 1990-1994 to 7.2% in 2000-2003. The percentage of patients referred since the first month of the apparent onset of the disease increased from 24.0% in 1980-1989 to 40.1% in 2000-2003 (p < 0.001). CONCLUSIONS: In Uruguay, the incidence of glomerulopathies with histological diagnosis has increased and the frequency of the different types has changed. Several indicators seem to show that the reference of patients to the nephrologist tended to be earlier in the last years.

[Chronic dialysis in Uruguay: mortality trends from 1981 to 1998]]. / Diálisis crónica en Uruguay: evolución de la mortalidad entre 1981 y 1998.

Uruguay is a developing country with 3.16 million inhabitants. Chronic dialysis treatment (CDT) expanded after the creation of a National Fund of Resources in 1980 who receives contribution from all inhabitants to finance, among others, the CDT and renal transplantation. During the 1981-1998 period, about 4,819 patients were treatment, 2,365 patients had died, 454 were transplanted and 51 patients were lost to follow-up due to change in residence. At the start of the treatment, mean age was 57.0 +/- 17.7 years, 37% were 65 or older than 65 year old, 61.3% were male and 98% of patients were white persons. The most common diseases responsible for End Stage Renal Disease were: hypertension (22%), chronic glomerulonephritis (19%) and diabetic nephropathy (15%). In 1998, there were 44 dialysis units in the country (13.6 units per million population--pmp), 100% of them had water treatment (reverse osmosis 96.8%) and reuse dialyzer. The most frequent causes of death were: cardiovascular and infection. In this paper, eighteen years of the mortality time course of CDT are analyzed. Annual mortality rate was expressed as deaths per 1,000 patients years at risk (M/1,000). The indirect standardization method was applied to adjust the mortality rate. Two populations were used as standard: the 1996 population of USRDS to adjust for age, sex, race and nephropathy and the 1996 Uruguayan general population to adjust for age. Standardized mortality rate (SMR) for each year was obtained dividing observed deaths by expected deaths. From 1981 to 1998, the incident population increased from 32 to 133 patients per million populations and the prevalent population from 28 to 639 pmp. There was a simultaneously increase in the prevalence of diabetic patients and of patients older than 65 years. The annual mortality rate decreased from 249 to 138 deaths per 1,000 patient years (M/1,000). The standardized mortality (SM) with the USRDS population as standard decreased from 452 in 1981 to 132 in 1998 and the SMR from 2.07 to 0.60. The SMR with the Uruguayan general population decreased from 17 to 4. In conclusion, these results are similar with those observed in developed countries. There has been a decrease both in the gross and the standardized mortality ratio in the period of observation.

Latin American Registry of dialysis and renal transplantation: 1993 annual dialysis data report.

BACKGROUND: The Latin American Registry of Dialysis and Transplantation was created in October 1991 and comprises the National Societies of Nephrology from 21 countries with a total population of 468.56 million inhabitants. METHODS: This report includes data from 21,181 patients from Argentina, Brazil, Chile, El Salvador, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela who were receiving chronic dialysis treatment during 1993. Data was collected by individual patient questionnaires except from Chile and Brazil where the data was obtained from a local centre questionnaire. RESULTS: The prevalence rate averaged 131.1 per million population. The mean age of the 8972 incident patients was 50.5 years, with 58.2% males. The more frequent causes of renal failure were glomerulopathies (22.6%), vascular nephropathy (20.9%) and diabetes (16.9%). Haemodialysis was the most used treatment (88.3%). Gross mortality was 21.1% and the more frequent causes of death were cardiac complications and infections. The analysis of mortality risk factors using a logistic regression model showed that diabetics patients older than 65 years had the highest probability of death (43.0%) and patients with glomerulonephritis, younger than 65 years had the lowest (8.0%). The adjusted mortality rate was 241 deaths/1000 patient-years at risk when the USRDS 1987-1989 white mortality rate by age groups and primary diseases was used as standard. CONCLUSION: In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.

Eleven years of chronic hemodialysis in Uruguay: mortality time course.

Uruguay is a developing country with 3.1 million inhabitants. Chronic dialysis treatment (CDT) began to spread after the creation of the National Fund of Resources (NFR) in 1980. This fund receives contribution from all inhabitants to finance, among others, the high cost treatment, dialysis and renal transplantation (RT). We analyzed the data base from 1981 to 1991 of the Hemodialysis National Registry to find the mortality time course. To compare with other populations, indirect standardization methods were used. Two thousand and seventy-one patients received chronic hemodialysis treatment (CHT) during the period cited. Incidence and prevalence of end-stage renal disease (ESRD) increased from 32 to 90 and from 38 to 390 patients per million population, respectively. Annual gross mortality decreased from 21 to 9% in spite of a simultaneous increase in the percentage of high risk patients. According to the age-matched national general mortality, the ratio between observed and expected deaths was 21 in 1981 and 4 in 1991. The standardized death rate was 142.8 deaths/1000 patient-years at risk when the USA ESRD 1987 to 1989 mortality rate by age, race and diagnosis was used as a standard. These results point out that it is possible to provide ESRD treatment in developing countries to achieve appropriate comparative results in delaying mortality.