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END STAGE RENAL DISEASE AND PREVENTION
STRATEGIES IN LATIN AMERICA
Latin America
Population 519,200,000 GNI 3550 dollars per
capita Life expectancy 70.5 years Human
development index 0.777 Increase population
1.5 annually Population gt 65 years old 5.6
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Life and healthy expectancy at birth in countries
of South and Central America and Caribbean
80
70
Years
60
50
40
Life expectancy
Healthy Life
at birth
expectancy

countries
(
Mean
95CI)
Industrialized
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SLANH 20 countries, population 509,565,697
LA Registry of Dialysis and Transplantation
Reports 1991-2001
Report 2000-2001 Dialysis 14/20 countries
(90 of LA population) Kidney Transplants from
18/20 countries, (96 of LA population)
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Transplants (x 1000)
55 Living donor (except Argentina, Chile,
Colombia, Cuba, Puerto Rico, Uruguay and
Venezuela)
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Latin American Registrty Treatment of ESRD, all
modalities, 1992-2001
(Courtesy Dr. Cusumano 2003)
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LATIN AMERICAN REGISTRY Prevalence by dialysis
modality, pmp, 31/12/01
Population 461913654
Dialysis Prevalence in Latin America 277.1
pmp HD 197 DP 80.1
Number of patients (14 countries, 90 LA pop.)
HDC 92767 DP 37727 (México 86), Living with
functioning kidney Tx 34044
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Dialysis incidence in LA 91.4 pmp
Theoretical Incidence 130 ppm Unmet demand 40
ppm Not getting dialysis 18842 pts Only 1/14
countries over the theoretical incidence
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Etiology ESRD
Others
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Diabetic nephropathy
Not defined
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Chronic GN
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Hypertension
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Diabetic nephropathy SLANH 2001 33 USRDS
2000 45 Australia 2001 25 New Zealand 37
EDTA-ERA 2000 22.4 Japan 2000
36.6
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Latin American Registry Progressive increase of
diabetic patients (1991-2001)

n 18486
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Some risk factors of ESRD in Latin America

• Diabetes

• Hypertension

• Low birth weight

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Direct Health costs of Diabetes in LA
Haiti
Per capita annual
direct costs of
Nicaragua
diabetes
Bolivia
Honduras
Per capita annual
health expenditure
Ecuador
Guatemala
Domin Rep
Peru
Cuba
Jamaica
El Salvador
Excess cost of diabetes 114 - 2517
Trinidad
Paraguay
Colombia
Mexico
Brazil
Costa Rica
Venezuela
Panama
Chile
The cost of diabetes in Latin America and the
Caribbean. Bull World Health Org 8120-23, 2003
Uruguay
Argentina
0
250
500
750
1000
US Dollars
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Hypertension In Latin America ()
Cuba prevalence 30 (50 gt60 años) known in
75 ()
() Consenso Latinoamericano sobre hipetensión
arterial. J Hypertens (Edición en Español)
61-27, 2001
() De la Osa JA. Hipertension arterial. //
consulta.cuba.cu Salazar J, Aguilar J.
Prevalencia de la hipetensión arterial en un
consultorio médico de familia. www.informed.sld.cu
/revistas/san
() Velazquez-Monroy et al. Arch Cardiol de
México. 7362-77, 2003
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Low birth weight in LA
mean industrialized
mean LA
countries
NIcaragua
Haiti
Guatemala
Ecuador
Bolivia
Rep Dominicana
Peru
El Salvador
Brasil
Trinidad
Jamaica
Colombia
Venezuela
Panamá
Honduras
Cuba
Uruguay
Mexico
Argentina
Costa Rica
Paraguay
Chile
0.0
2.5
5.0
7.5
10.0
12.5
15.0
live births with lt2500g
//utal.org/segsocial/index.htm 1998
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Prevention Strategies

• To continue and increment COMGAN participation
  in LA Nephrological activities with emphasis on
  prevention

• Support and advise in the design of
  epidemiologic studies

• Support efforts to engage governments in
  prevention of
• ESRD (ej. Renal health model beeing implemented
  in Valdivia)

• Free access to full text publications to
  strengthen academic nephrology.

• Reduce cost of medications with the potential to
  retard progression of ESRD

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COMGAN has supported events in all LA countries

• Invited speakers
• Simposia
• Side visits
• Fact finding trips

• To continue and increment COMGAN participation
  in LA Nephrological activities with emphasis on
  prevention

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• Support and advise in the design of
  epidemiologic studies

Only 48 of the studies published between 1966
and 2000 to estimate the prevalence of
hypertension in Latin America meet a critical
thereshold to be useful for surveillance purposes
Ordúñez P, Silva LC, Paz M, Robles S.
Prevalence estimates for hypertension in Latin
America and the Caribbean Are they useful for
surveillance? Pan Am J Public Health 10226-230,
2001
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• Support efforts to engage the government in
  prevention of
• ESRD (ej. Renal health model beeing implemented
  in Valdivia)

Conjunto deAcciones para laReducciónMultifactor
ial de lasEnfermedadesNo transmisibles
PAHO
Sustenable and tenable renal health model. A
Latin American proposal
Rafael Burgos Santos Delpine
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Prevention Strategies

• To continue and increment COMGAN participation
  in LA Nephrological activities with emphasis on
  prevention

• Support and advise in the design of
  epidemiologic studies

• Support efforts to engage governments in
  prevention of
• ESRD (ej. Renal health model beeing implemented
  in Valdivia)

• Free access to full text publications to
  strengthen academic nephrology.

• Reduce cost of medications with the potential to
  retard progression of ESRD

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World Total of Internet Users 605.6 million
182.67 millions
190.91 millions
5.12 millions
187.24 millions
33.35 millions
6.31 millions
Source Jupitermedia CorporationNua Internet
surveys, Sept 2002
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Prevention Strategies

• To continue and increment COMGAN participation
  in LA Nephrological activities with emphasis on
  prevention

• Support and advise in the design of
  epidemiologic studies

• Support efforts to engage governments in
  prevention of
• ESRD (ej. Renal health model beeing implemented
  in Valdivia)

• Free access to full text publications to
  strengthen academic nephrology.

• Reduce cost of medications with the potential to
  retard progression of ESRD

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POPULATION BELOW POVERTY LINE IN LATIN AMERICA
of the population that lives on less than 1 USA
per day (International Poverty Line)
Source www.uniceflac.org 2000/indicadores)
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POPULATION WITHOUT ADEQUATE SANITATION IN LATIN
AMERICA
In Canada and USA 0.16
In Latin América/Caribbean 104.316.814
inhabitants (21.9 of the total population) do
not have adequate sanitation services. (Cidutal
Estadísticas Abril 15, 2003)
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POPULATION WITHOUT POTABLE WATER IN LATIN AMERICA
Canada, USA) 0.02
In Latin América/Caribbean 72.968.187 inhabitants
(15.3 of the total population) do not have
access to drinkable water. (Cidutal Estadísticas
April 15, 2003
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(LA nations)
WHO. WHR 2002
Leading 10 selected risk factors as percentage
causes of disease burden measured in DALYs