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.

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.

Beneficio del stent coronario en la reducción de complicaciones cardiacas mayores en síndromes coronarios agudos / Benefit of coronary stenting in the reduction of major adverse cardiac events in acute coronary syndromes

Con el objetivo de evaluar la incidencia de complicaciones cardiacas mayores durante la evolución intrahospitalaria, se analizaron 694 procedimientos realizados en 613 pacientes durante un año. Se estudiaron 550 (79.2 por ciento) pacientes con angina inestable, 43 (6.2 por ciento) con angina estable y 101 (14.5 por ciento) con infarto agudo del miocárdio. La angioplastía coronaria transluminal percutánea (ACTP) fue electiva en 593 pacientes (85.4 por ciento), de rescate en 7 (1 por ciento) y primaria en 94 (13.5 por ciento). Las lesiones intervenidas fueron tipo A 30 por ciento, tipo B 58 por ciento y tipo C 12 por ciento. El éxito técnico alcanzado, fue del 95 por ciento y clínico del 80 por ciento. Los pacientes sometidos a implantación de stent coronario fueron comparados con pacientes tratados con angioplastía coronaria convencional. La tasa global de mortalidad fué del 1 por ciento en el grupo con stent y del 3 por ciento en el grupo de ACTP. La incidencia de complicaciones cardiacas mayores fue del 4 por ciento y 15.1 por ciento en pacientes con stent y ACTP con balón. Se encontró una disminución significativa en la incidencia de complicaciones mayores en el grupo de pacientes con angina inestable (p= 0.0001) y con infarto agudo del miocardio (p= 0.0001) sometidos a implantación de stent. El mayor fue una disminución en la necesidad de reintervenir la arteria tratada

Arteriografía coronaria y aortografía por vía translumbar en un paciente con arteritis de Takayasu / Transumbalar coronary arteriography in a patient with Takayasu's arteritis

Desde su introducción por Dos Santos en 1929, la arteriografía por abordaje translumbar ha sufrido algunas transformaciones. En la actualidad ha sido reemplazadas por otros abordajes percutáneos y está indicada solamente cuando esas vías de acceso han fallado debido a obstrucciones aortoiliacas o subclavias. Este artículo presenta una paciente con arteritis de Takayasu con enfermedad severa de arterias periféricas y angina inestable, a quien se le realizó arteriografía coronaria y aortografía por vía translumbar. Se realiza una revisión de la técnica en mención

Utilidad de la determinación cualitativa rápida de Troponina-T, fracción MB de creatina fosfocinasa y mioglobina en los síndromes isquémicos coronarios agudos / Utility of a rapid bedside assay of cardiac troponine T, creatinphosphoquinase-MB and myoglobin in acute ischemic coronary syndromes

Con el objeto de validar la utilidad diagnóstica de la troponina T, CK-MB y mioglobina como marcadores cualitativos en los síndromes isquémicos coronarios agudos, así como en casos de dificultad diagnóstica, las analizamos mediante pruebas de concordancia y las comparamos contra métodos enzimáticos cuantitativos convencionales. Determinamos la sensibilidad, especificidad y valores predictivos positivos o negativos de la curva enzimática cuantitativa. La significancia estocástica fue valorada mediante pruebas de X² cuadrada y de Mcnemar, en 70 pacientes que ingresaron al servicio de Urgencias con dolor precordial, y que fueron asignados en cinco diferentes grupos. La sensibilidad de los métodos cualitativos sin embargo con menor tasa de verosimilitud. El análisis de concordancia entre las pruebas cuantitativas y cualitativas fue adecuado: Indice de Kappa de 0.65 p<0.05. El estudio sugiere que la Troponina T es un buen marcador diagnóstico comparado con los métodos cuantitativos convencionales