Latin American Dialysis and Renal Transplant Registry: 2008 report (data 2006).

INTRODUCTION: Between 1991 and 2006, the Latin American Dialysis and Renal Transplantation Registry collected data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay). Access to RRT was universal in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay, all countries belonging to the medium-high or high income group. METHODS: Data about patients on renal replacement therapy (RRT) were supplied by national affiliates or the Registry's Coordination Committee. Transplant data were gathered and shared with the Latin American and Caribbean Society of Transplantation. RESULTS: RRT prevalence increased from 162 patients per million population (pmp) in 1991 to 478 pmp in 2005 and 473 pmp in 2006 (59.2% hemodialysis, 20.4% peritoneal dialysis and 20.4% with a functioning kidney allograft). Countries with the highest prevalence were Puerto Rico (1,148.9 pmp), Uruguay (924.5 pmp) and Chile (907.6 pmp). Latin America's (LA) incidence increased from 27.8 pmp in 1992 to 188 pmp in 2006. The LA Kidney transplant rate increased from 3.7 pmp in 1987 to 15,4 pmp in 2006, and 166 combined transplants - kidney and another organ, mainly pancreas - were performed. In the medium-high income group 2006, (Argentina, Brazil, Chile, Costa Rica, Cuba, Mexico, Panama, Uruguay, Venezuela) the prevalence rate was 534.8 pmp vs. 289.5 pmp in the middle-low income group. The transplant rate was 18.4 pmp in the medium-high income group vs. 7 pmp in the middle-low group (p < 0.01). CONCLUSIONS: RRT incidence and prevalence continue to grow steadily. Access to RRT is universal only in some countries included in the medium-high or high income group. It is imperative to accomplish the goal of making RRT available to all who need it.

Prevention of CKD in Guatemala.

The rapidly growing burden of chronic kidney diseases (CKD) is a major public health problem that will stretch the healthcare system of all countries, especially those not yet industrialized. Guatemala has a population of approximately 14 million, of which 60% are younger than 20 years. It is estimated that only 35% of Guatemalan patients with CKD Stage 5 (ESRD) are diagnosed and treated. Therefore, the cost of death and disability due to CKD in this young population is particularly profound. CKD programs have to compete with many demands (often viewed in the short term as more urgent or widespread) for finite healthcare resources. FUNDANIER (Foundation for Children with Kidney Diseases) has been the instrument that facilitated changes in the Guatemalan health system, in order to establish a comprehensive Pediatric Nephrology program. FUNDANIER is the first local initiative to provide comprehensive prevention and management of kidney disease in children and adolescents in Guatemala. Through an agreement with the National Health Authorities, FUNDANIER is involved in the primary, secondary and tertiary prevention of CKD in the pediatric population. This might be a model applicable in other developing countries.

Follow-up study of renal transplant recipients treated at the Guatemalan Social Security Hospital.

Guatemala is Central America's westernmost country, with a ratio of 500,000 inhabitants per nephrologist. Yearly reports show an average of 150 new end-stage renal disease patients and 40 renal transplants, which are performed at two public health care facilities. The aim of this study was to describe the results of the transplant program at one of these centers (Social Security Hospital of Guatemala). Our program began in 1986, performing an average of 17 transplants per year. Cyclosporine has been used since 1992, and since 2001, C2 has been routinely monitored. Data on 255 patients (of 293) were available for analysis. Male-to-female ratio was 7:1, with 94% having received hemodialysis as their replacement therapy. The mean age at transplant was 35 years and living related donors used in 95%. The average duration of follow-up was 7 years. The mean creatinine and C2 level at most recent visit were 1.36 mg/dL and 864 ng/mL, respectively. A significant reduction in the incidence of acute rejection episodes was seen after the initiation of C2 monitoring (3% vs 1.2%). In general, these results are similar to data in other countries. The number of transplants performed must be increased to meet the current demand, and the cadaveric source of donation is the obvious way to do so. C2 monitoring is an example of technical improvements directed to optimize available resources.