Advances in Hemodialysis in the Last Decade in Latin America.

UNASSIGNED: Kidney replacement therapy (KRT) initiated in Latin America towards the second half of the 20th century, starting with dialytic therapies and, shortly thereafter, with kidney transplant. By the end of 2021, close to half a million Latin Americans were under KRT, with an overall unadjusted prevalence of 872 per million persons (pmp), yet with significant heterogeneity between nations. By treatment modality, 68% of prevalent patients were treated with hemodialysis (HD), 9% with peritoneal dialysis (PD), and 23% were living with a functioning kidney graft (LFG). In the last decade, HD is the KRT that has had the largest growth, and it also has incorporated newer and better technologies. Nevertheless, Latin America shows heterogeneity between countries, and as a region we are far from achieving full accessibility to all in need of KRT. While there has been growth and improvement in existing renal dialysis registries, and several countries that did not previously have these registries have implemented them, there are still some nations with limited or absent registry implementation. The number of nephrologists in the region is heterogeneous, with only four countries having an appropriate group of specialists. The remaining nations have an important need to expand nephrology training programs. SLANH is a major regional player in addressing these topics and supporting the expansion of appropriate nephrology programs to improve inequalities and patient care. (Rev Invest Clin. 2023;75(6):300-8).

Burden of disease: Closing the gaps in the burden of end-stage kidney disease in Latin America.

End-stage kidney disease (ESKD) represents a major challenge for Latin America (LA). The Latin American Dialysis and Renal Transplantation Registry (LADRTR) has published several reports, and its continuity has implied a sustained effort of the nephrology community to improve care of ESKD in the region; this paper summarizes results of the year 2014. Methods have been reported previously; participant countries complete annual surveys collecting data on incident and prevalent patients undergoing renal replacement therapy (RRT) in all modalities. 20 countries participated in the surveys (more than 90% of the region). Prevalence of treated ESKD in RRT increased from 119 patients per million population (pmp) in 1991 to 709 pmp in 2014; hemodialysis continues to be the treatment of choice in the region (68%). A wide variation was observed in the incidence rate, from 421 pmp in Jalisco (Mexico) to 23 pmp in Paraguay; diabetes was the cause of 36% of incident cases. Additionally, great heterogeneity was observed in the number of nephrologists by country, from 2 pmp in Colombia to 53 pmp in Uruguay. Heterogeneity, or even absence of registries in some LA countries, is concordant with inequities in RRT access as well as with the limited availability of qualified personnel. The LADRTR is leading the personnel training to develop and strengthen national dialysis and transplant registries in LA within the frame of the Pan-American Health Organization (PAHO) - Sociedad Latinoamericana de Nefrología e Hipertension (SLANH) cooperation program.

The epidemiology of renal replacement therapy in two different parts of the world: the Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry.

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.

Burden of end-stage renal disease (ESRD) in Latin America.

INTRODUCTION: End-stage renal disease (ESRD) represents a major challenge for Latin America (LA). Epidemiological information needed to assist in the development of ESRD care in the region. The Latin American Dialysis and Renal Transplant Registry (RLADTR), has published several reports and its continuity has implied a sustained effort of the entire LA Nephrology community. This paper summarizes the results corresponding to year 2012. METHODS: Our methods have been reported previously. Participant countries complete an annual survey collecting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities. RESULTS: 20 countries participated in the surveys, more than 90% of the Latin America. The prevalence of ESRD under RRT in LA increased from 119 patients Per million population (pmp) in 1991 to 661 pmp in 2012. HD continues to be the treatment of choice in the region (82%). A wide rate variation in incidence is observed: from 472.7 in Jalisco (Mexico) to 14 pmp in Guatemala. Diabetes remained the leading cause of ESRD. The most frequent cause of death was cardiovascular. There is a wide rate variation of nephrologist by country, from 1.8 pmp in Honduras to 45.2 pmp in Cuba. DISCUSSION: The heterogeneity or even absence of registries in some LA countries is congruent with the inequities in access to RRT in such countries, as well as the availability of qualified personnel. The SLANH is currently running training programs as well as cooperation programs between LA countries to help the least developed start ESRD programs. In this spirit, RLADTR is training personnel to carry out dialysis and transplant registries in LA.

National kidney dialysis and transplant registries in Latin America: how to implement and improve them.

The Strategic Plan of the Pan American Health Organization, 2014-2019, Championing Health: Sustainable Development and Equityrecognizes that "Chronic kidney disease, caused mainly by complications of diabetes and hypertension, has increased in the Region." This Plan includes the first concrete goal on chronic kidney disease: to achieve a prevalence rate for renal replacement therapy of at least 700 patients per million population by 2019. National dialysis and transplant registries (DTR) are a useful tool for epidemiological research, health care planning, and quality improvement. Their success depends on the quality of their data and quality control procedures. This article describes the current situation of national DTRs in the Region and the content of their information and health indicators, and it offers recommendations for creating and maintaining them. It points to their heterogeneity or absence in some countries, in line with the inequities that patients face in access to renal replacement therapy. The complete lack of information in Caribbean countries prevents their inclusion in this communication, which requires immediate attention.

Sex- and Gender-Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines.

BACKGROUND: Hypertension is the leading modifiable cardiovascular risk factor with recognized sex- and gender-based differences. We assessed the incorporation of sex and gender reporting in the antihypertensive medication literature informing hypertension guidelines. METHODS AND RESULTS: Literature cited in the International Society of Hypertension (2020), European Society of Cardiology/European Society of Hypertension (2018), American College of Cardiology/American Heart Association (2017), Latin American Society of Hypertension (2017), Pan-African Society of Cardiology (2020), and Hypertension Canada (2020) guidelines was systematically reviewed. Observational studies, randomized controlled trials, and systematic reviews involving antihypertensive medications were included. Studies with participants of a single sex, guidelines, and commentaries were excluded. Data on study participation-to-prevalence ratio by sex, analysis of baseline demographics and study outcomes by sex, and stratification of adverse events by sex were extracted. Of 1659 unique citations, 331 studies met inclusion criteria. Of those, 81% reported the sex of participants, and 22% reported a male-to-female participation-to-prevalence ratio of 0.8 to 1.2. Three percent of studies stratified baseline characteristics by sex, and 20% considered sex during analysis through statistical adjustment or stratification. Although 32% of studies reported adverse events, only 0.6% stratified adverse events by sex. Most (58%) studies reporting sex/gender used sex and gender terms interchangeably. CONCLUSIONS: Incorporation of sex- and gender-based considerations in study population, analysis, or reporting of results and adverse events is not common in the antihypertensive medication literature informing international hypertension guidelines. Greater attention to sex- and gender-based factors in research is required to optimally inform management of hypertension.

The Latin American Dialysis and Renal Transplantation Registry: report 2019.

BACKGROUND: Chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to the burden of disease it causes and the difficulty in accessing treatment. LA has a total population of 652 million people living in 20 countries that occupy an area of 19.2 million km2. The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. This article summarizes the registry data for 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 per million population (pmp). Regarding treatment modality, 66.7% of the prevalent patients were treated with HD and 9.3% with PD while 24% of the patients had an LFG. A total of 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 CKD of nontraditional causes. The kidney transplant rate in the region was 22 pmp, varying from 1 to >60 pmp. The total prevalence of KRT correlated positively with GDP per capita (r 2 = 0.6, P < 0.01) and LEB (r 2 = 0.23, P < 0.05). The overall incidence rate also significantly correlated with GDP (r 2 = 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.

Step-by-step guide to setting up a kidney replacement therapy registry: the challenge of a national kidney replacement therapy registry.

Chronic kidney disease (CKD) has become one of the most important public health problems worldwide. Analysis, and understanding, of this global/national/regional reality would benefit from renal registry databases. 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 most severe subgroup in terms of comorbidities and healthcare costs. A kidney replacement therapy registry (KRTR) is defined as the systematic and continuous collection of a population-based data set from ESKD patients treated by dialysis/kidney transplant. The lack of available data, particularly in emerging economies, leaves information gaps on healthcare and outcomes in these patients. The heterogeneity/absence of a KRTR in some countries is consistent with the inequities in access to KRT worldwide. In 2014, the Pan American Health Organization (PAHO) proposed to determine the prevalence of patients on dialysis for at least 700 patients per million inhabitants by 2019 in every Latin American (LA) country. Since then, PAHO and the Sociedad LatinoAmericana de Nefrología e Hipertensión have provided training courses and certification of KRTR in LA. The purpose of this manuscript is to provide guidance on how to set up a new KRTR in countries or regions that still lack one. Advice is provided on the sequential steps in the process of setting up a KRTR, personnel requirements, data set content and minimum quality indicators required.

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America.

Latin America is a region with a widely variable socioeconomic landscape, facing a surge in noncommunicable diseases, including chronic kidney disease and kidney failure, exposing significant limitations in the delivery of care. Despite region-wide efforts to explore and address these limitations, much uncertainty remains as to the capacity, accessibility, and quality of kidney failure care in Latin America. Through this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to report on these indicators to provide a comprehensive map of kidney failure care in the region. Survey responses were received from 18 (64.2%) countries, representing 93.8% of the total population in Latin America. The median prevalence and incidence of treated kidney failure in Latin America were 715 and 157 per million population, respectively, the latter being higher than the global median (142 per million population), with Puerto Rico, Mexico, and El Salvador experiencing much of this growing burden. In most countries, public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) care, with patients incurring at least 1% to 25% of out-of-pocket costs. In most countries, >90% of dialysis patients able to access kidney replacement therapy received hemodialysis (n = 11; 5 high income and 6 upper-middle income), and only a small minority began with peritoneal dialysis (1%-10% in 67% of countries; n = 12). Few countries had chronic kidney disease registries or targeted detection programs. There is a large variability in the availability, accessibility, and quality of kidney failure care in Latin America, which appears to be subject to individual countries' funding structures, underreliance on cheap kidney replacement therapy, such as peritoneal dialysis, and limited chronic kidney disease surveillance and management initiatives.

Advances in Hemodialysis in the Last Decade in Latin America

ABSTRACT Kidney replacement therapy (KRT) initiated in Latin America towards the second half of the 20th century, starting with dialytic therapies and, shortly thereafter, with kidney transplant. By the end of 2021, close to half a million Latin Americans were under KRT, with an overall unadjusted prevalence of 872 per million persons (pmp), yet with significant heterogeneity between nations. By treatment modality, 68% of prevalent patients were treated with hemodialysis (HD), 9% with peritoneal dialysis (PD), and 23% were living with a functioning kidney graft (LFG). In the last decade, HD is the KRT that has had the largest growth, and it also has incorporated newer and better technologies. Nevertheless, Latin America shows heterogeneity between countries, and as a region we are far from achieving full accessibility to all in need of KRT. While there has been growth and improvement in existing renal dialysis registries, and several countries that did not previously have these registries have implemented them, there are still some nations with limited or absent registry implementation. The number of nephrologists in the region is heterogeneous, with only four countries having an appropriate group of specialists. The remaining nations have an important need to expand nephrology training programs. SLANH is a major regional player in addressing these topics and supporting the expansion of appropriate nephrology programs to improve inequalities and patient care.

Latin American Dialysis and Transplant Registry: Experience and contributions to end-stage renal disease epidemiology.

In 2015, 634387 million people (9% of the world's population) resided in Latin America (LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy (RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were (in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice (90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.

Renal replacement therapy in Latin American end-stage renal disease.

The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit.

The epidemiology of renal replacement therapy in two different parts of the world: the Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry

[ABSTRACT]. 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.

[RESUMEN]. Objetivo. Comparar los datos epidemiológicos del tratamiento sustitutivo de la función renal (TSFR) para la nefropatía terminal en América Latina y Europa, así como estudiar las diferencias en cuanto a indicadores macroeconómicos, características demográficas y clínicas de los pacientes, tasas de mortalidad y causas de defunción entre estas dos poblaciones. Métodos. Utilizamos los datos de 20 registros renales latinoamericanos y 49 europeos, a nivel nacional y subnacional, que le habían proporcionado datos al Registro Latinoamericano de Diálisis y Trasplante Renal (RLADTR) y al Registro de la Asociación Europea Renal–Asociación Europea de Diálisis y Trasplantes (ERA-EDTA, por su sigla en inglés), respectivamente. Se calculó la incidencia y la prevalencia del TSFR en el 2013 por millón de habitantes, en total y por subcategoría (edad, sexo, nefropatía primaria y modalidad de tratamiento). Se analizó la correlación entre el producto interno bruto y la prevalencia de TSFR mediante regresión lineal. Se evaluaron las tendencias en la prevalencia de TSFR entre el 2004 y el 2013 mediante un análisis de regresiones lineales segmentadas. Resultados. En el 2013, la incidencia general al día 91 después de iniciar el tratamiento sustitutivo de la función renal era de 181 por millón de habitantes en los países latinoamericanos y de 130 en los países europeos. La prevalencia general era de 660 por millón de habitantes para América Latina y de 782 para Europa. En los países latinoamericanos, el aumento anual promedio de la prevalencia fue de 4,0% (intervalo de confianza de 95% [IC]: 2,5%-5,6%) entre el 2004 y el 2013, mientras que los países europeos registraron un aumento anual promedio de 2,2% (IC de 95%: 2,0%-2,4%) durante el mismo período. La tasa bruta de mortalidad fue mayor en América Latina que en Europa (112 defunciones por 1 000 años-paciente, en comparación con 100 defunciones), y las enfermedades cardiovasculares fueron la principal causa de muerte en ambas regiones. Conclusiones. Hay considerables diferencias entre América Latina y Europa en cuanto a los datos epidemiológicos del tratamiento sustitutivo de la función renal para la nefropatía terminal. Es necesario hacer más investigaciones para explorar las razones de tales diferencias.

[RESUMO]. Objetivo. Comparar o perfil epidemiológico de pacientes com doença renal em estágio final (DREF) em terapia renal substitutiva (TRS) na América Latina e na Europa e examinar as diferenças nos indicadores macroeconômicos, características demográficas e clínicas, taxas de mortalidade e causas de morte entre as duas populações de pacientes. Métodos. O estudo foi baseado em informação de 20 registros latino-americanos e 49 registros nacionais e subnacionais europeus que haviam fornecido dados ao Registro Latino-Americano de Diálise e Transplante Renal (RLADTR) e Registro da Associação Europeia de Nefrologia e Associação Europeia de Diálise e Transplante (ERA-EDTA), respectivamente. A incidência e a prevalência de TRS em 2013 foram calculadas por milhão de habitantes (pmh), geral e por subcategorias de idade, sexo, doença renal primária e modalidade de tratamento. A correlação entre o produto interno bruto (PIB) e a prevalência de TRS foi analisada com o uso de regressão linear. Tendências na prevalência de TRS entre 2004 e 2013 foram analisadas com o uso de regressão linear segmentada. Resultados. Em 2013, a incidência geral ao dia 91 do início de TRS foi 181 pmh nos países latino-americanos e 130 pmh nos países europeus. Observou-se uma prevalencia geral de TRS de 660 pmh na América Latina e 782 pmh na Europa. No período 2004–2013, o aumento médio anual da prevalência foi de 4,0% (intervalo de confiança de 95% [IC 95%] 2,5%–5,6%) nos países latino-americanos, enquanto que houve um aumento médio anual de 2,2% (IC 95% 2,0%–2,4%) nos países europeus. A taxa de mortalidade bruta foi maior na América Latina que na Europa (112 versus 100 óbitos por 1.000 pacientes-anos) e doença cardiovascular foi a principal causa de morte em ambas as regiões. Conclusões. Existem diferenças consideráveis entre a América Latina e a Europa no perfil epidemiológico dos pacientes com DREF em TRS. Outras pesquisas devem ser realizadas para investigar mais a fundo estas diferenças.

The epidemiology of renal replacement therapy in two different parts of the world: the Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry / Datos epidemiológicos del tratamiento sustitutivo de la función renal en dos partes del mundo: el Registro Latinoamericano de Diálisis y Trasplante Renal frente al Registro de la Asociación Europea de Nefrología y Asociación Europea de Diálisis y trasplante / Epidemiologia da terapia renal substitutiva em dois pontos distintos do planeta: Registro Latino-Americano de Diálise e Transplante Renal e Registro da Associação Europeia de Nefrologia e Associação Europeia de Diálise e Transplante

ABSTRACT 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.

RESUMEN Objetivo Comparar los datos epidemiológicos del tratamiento sustitutivo de la función renal (TSFR) para la nefropatía terminal en América Latina y Europa, así como estudiar las diferencias en cuanto a indicadores macroeconómicos, características demográficas y clínicas de los pacientes, tasas de mortalidad y causas de defunción entre estas dos poblaciones. Métodos Utilizamos los datos de 20 registros renales latinoamericanos y 49 europeos, a nivel nacional y subnacional, que le habían proporcionado datos al Registro Latinoamericano de Diálisis y Trasplante Renal (RLADTR) y al Registro de la Asociación Europea Renal-Asociación Europea de Diálisis y Trasplantes (ERA-EDTA, por su sigla en inglés), respectivamente. Se calculó la incidencia y la prevalencia del TSFR en el 2013 por millón de habitantes, en total y por subcategoría (edad, sexo, nefropatía primaria y modalidad de tratamiento). Se analizó la correlación entre el producto interno bruto y la prevalencia de TSFR mediante regresión lineal. Se evaluaron las tendencias en la prevalencia de TSFR entre el 2004 y el 2013 mediante un análisis de regresiones lineales segmentadas. Resultados En el 2013, la incidencia general al día 91 después de iniciar el tratamiento sustitutivo de la función renal era de 181 por millón de habitantes en los países latinoamericanos y de 130 en los países europeos. La prevalencia general era de 660 por millón de habitantes para América Latina y de 782 para Europa. En los países latinoamericanos, el aumento anual promedio de la prevalencia fue de 4,0% (intervalo de confianza de 95% [IC]: 2,5%-5,6%) entre el 2004 y el 2013, mientras que los países europeos registraron un aumento anual promedio de 2,2% (IC de 95%: 2,0%-2,4%) durante el mismo período. La tasa bruta de mortalidad fue mayor en América Latina que en Europa (112 defunciones por 1 000 años-paciente, en comparación con 100 defunciones), y las enfermedades cardiovasculares fueron la principal causa de muerte en ambas regiones. Conclusiones Hay considerables diferencias entre América Latina y Europa en cuanto a los datos epidemiológicos del tratamiento sustitutivo de la función renal para la nefropatía terminal. Es necesario hacer más investigaciones para explorar las razones de tales diferencias.

RESUMO Objetivo Comparar o perfil epidemiológico de pacientes com doença renal em estágio final (DREF) em terapia renal substitutiva (TRS) na América Latina e na Europa e examinar as diferenças nos indicadores macroeconômicos, características demográficas e clínicas, taxas de mortalidade e causas de morte entre as duas populações de pacientes. Métodos O estudo foi baseado em informação de 20 registros latino-americanos e 49 registros nacionais e subnacionais europeus que haviam fornecido dados ao Registro Latino-Americano de Diálise e Transplante Renal (RLADTR) e Registro da Associação Europeia de Nefrologia e Associação Europeia de Diálise e Transplante (ERA-EDTA), respectivamente. A incidência e a prevalência de TRS em 2013 foram calculadas por milhão de habitantes (pmh), geral e por subcategorias de idade, sexo, doença renal primária e modalidade de tratamento. A correlação entre o produto interno bruto (PIB) e a prevalência de TRS foi analisada com o uso de regressão linear. Tendências na prevalência de TRS entre 2004 e 2013 foram analisadas com o uso de regressão linear segmentada. Resultados Em 2013, a incidência geral ao dia 91 do início de TRS foi 181 pmh nos países latino-americanos e 130 pmh nos países europeus. Observou-se uma prevalência geral de TRS de 660 pmh na América Latina e 782 pmh na Europa. No período 2004-2013, o aumento médio anual da prevalência foi de 4,0% (intervalo de confiança de 95% [IC 95%] 2,5%-5,6%) nos países latino-americanos, enquanto que houve um aumento médio anual de 2,2% (IC 95% 2,0%-2,4%) nos países europeus. A taxa de mortalidade bruta foi maior na América Latina que na Europa (112 versus 100 óbitos por 1.000 pacientes-anos) e doença cardiovascular foi a principal causa de morte em ambas as regiões. Conclusões Existem diferenças consideráveis entre a América Latina e a Europa no perfil epidemiológico dos pacientes com DREF em TRS. Outras pesquisas devem ser realizadas para investigar mais a fundo estas diferenças.

Latin American Dialysis and Transplant Registry: 2008 prevalence and incidence of end-stage renal disease and correlation with socioeconomic indexes.

In 2008, 563,294,000 people were living in Latin America (LA), of which 6.6% were older than 65. The region is going through a fast demographic and epidemiologic transition process, in the context of an improvement in socio-economic indices. The Latin American Dialysis and Renal Transplant Registry has collected data since 1991, through an annual survey completed by 20 affiliated National Societies. Renal replacement treatment (RRT) prevalence and incidence showed an increase year by year. The prevalence rate (in all modalities) correlated with the World Bank country classification by income and the epidemiologic transition stage the countries were experiencing. RRT prevalence and kidney transplantation rates correlated significantly with gross national income (GNI), health expenditure in constant dollars (HeExp), % older than 65, life expectancy at birth, and % of the population living in urban settings. Kidney transplantation increased also, year by year, with more than 50% of transplants performed using kidneys from deceased donors. Double transplants were performed in six countries. RRT prevalence and incidence increased in LA, and are associated with indexes reflecting higher and more evenly distributed national wealth (GNI and HeExp), and the stage of demographic and epidemiological transition.

Los registros nacionales de diálisis y trasplante renal en América Latina: cómo implementarlos y mejorarlos

El Plan Estratégico de la Organización Panamericana de la Salud, 2014-2019, En pro de la salud: Desarrollo sostenible y equidad, reconoce que “La enfermedad renal crónica causada principalmente por las complicaciones de la diabetes y la hipertensión ha aumentado en la Región”. En él se define por primera vez una meta concreta sobre la enfermedad renal crónica: alcanzar una prevalencia del tratamiento de sustitución de la función renal de por lo menos 700 pacientes por millón de habitantes en 2019. Los Registros de Diálisis y Trasplante (RDT) nacionales constituyen una herramienta útil para la investigación epidemiológica, la planificación de la atención de salud y la mejora de su calidad. Su éxito depende de la calidad de sus datos y los procedimientos de control de calidad. En este artículo se describen la situación actual de los RDT nacionales de la Región, sus contenidos informativos e indicadores de calidad, y ofrecen recomendaciones para crearlos y mantenerlos. Se destaca su heterogeneidad o ausencia en algunos países en consonancia con las inequidades de acceso a los tratamientos de reemplazo renal que afrontan los pacientes. La carencia total de información en países del Caribe impide incluirlos en esta comunicación, lo que requiere inmediata atención.

Los registros nacionales de diálisis y trasplante renal en América Latina: cómo implementarlos y mejorarlos / National kidney dialysis and transplant registries in Latin America: how to implement and improve them

El Plan Estratégico de la Organización Panamericana de la Salud, 2014-2019, En pro de la salud: Desarrollo sostenible y equidad, reconoce que "La enfermedad renal crónica causada principalmente por las complicaciones de la diabetes y la hipertensión ha aumentado en la Región". En él se define por primera vez una meta concreta sobre la enfermedad renal crónica: alcanzar una prevalencia del tratamiento de sustitución de la función renal de por lo menos 700 pacientes por millón de habitantes en 2019. Los Registros de Diálisis y Trasplante (RDT) nacionales constituyen una herramienta útil para la investigación epidemiológica, la planificación de la atención de salud y la mejora de su calidad. Su éxito depende de la calidad de sus datos y los procedimientos de control de calidad. En este artículo se describen la situación actual de los RDT nacionales de la Región, sus contenidos informativos e indicadores de calidad, y ofrecen recomendaciones para crearlos y mantenerlos. Se destaca su heterogeneidad o ausencia en algunos países en consonancia con las inequidades de acceso a los tratamientos de reemplazo renal que afrontan los pacientes. La carencia total de información en países del Caribe impide incluirlos en esta comunicación, lo que requiere inmediata atención.

The Strategic Plan of the Pan American Health Organization, 2014-2019, Championing Health: Sustainable Development and Equityrecognizes that "Chronic kidney disease, caused mainly by complications of diabetes and hypertension, has increased in the Region." This Plan includes the first concrete goal on chronic kidney disease: to achieve a prevalence rate for renal replacement therapy of at least 700 patients per million population by 2019. National dialysis and transplant registries (DTR) are a useful tool for epidemiological research, health care planning, and quality improvement. Their success depends on the quality of their data and quality control procedures. This article describes the current situation of national DTRs in the Region and the content of their information and health indicators, and it offers recommendations for creating and maintaining them. It points to their heterogeneity or absence in some countries, in line with the inequities that patients face in access to renal replacement therapy. The complete lack of information in Caribbean countries prevents their inclusion in this communication, which requires immediate attention.