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)

Abstract

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.

Keywords: Latin America; dialysis; economic burden; health care access; kidney disease; kidney replacement therapy.

Figure 1

Countries of the International Society of Nephrology LatinAmerica region.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT), globally and in the International Society of Nephrology Latin America region. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. AKI, acute kidney injury; HD, hemodialysis; N/A, not applicable; NGO, nongovernment organization; PD, peritoneal dialysis.

Figure 3

Availability of choice in kidney replacement therapy (KRT) or conservative kidney management (CKM) for people with kidney failure in the International Society of Nephrology Latin America region. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. HD, hemodialysis; Kt/V, measure of dialysis adequacy; N/A, not applicable; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 4

Available services to diagnose and treat complications of kidney failure in the International Society of Nephrology Latin America region. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. BP, blood pressure; Hb, hemoglobin; PTH, parathyroid hormone.