Latin American Dialysis and
Transplantation Registry
Ana María Cusumano April 13, 2011
WCN2011
8th Conference on Kidney
Disease in Disadvantaged
Populations
Latin American Society of Nephrology and Hypertension (SLANH)
Latin-America 2008
Population: 563 294 000 inhab. (includes PR) Population growth: 1.1%
Older than 65 yrs old: 6.6% (4.2-13.7)
Health expenditure per capita: $ 717,5 (range 218-1322) % urban population: 73 (range 61-98)
Improvement in socio-economic indexes 2000-2008:
• GNI per capita: 3300 to 7012
• Life expectancy at birth: 71.6 to 73.4. • % poor people (1999-2007) 43,8 to 34,1% • % indigent population: 18,5 to 13,3%
Latin american countries
¨ All classified, according to GNI, among low middle income and high middle
income, except Puerto Rico (high income)
¨ Epidemiological & Demographic transition on-going:
Stages demograpic trasition
Stage 1 Stage 2 Stage 3 Stage 4 Incipient Moderate Full Advanced
Time B i r t h & D e a t h r a t e Guatemala Haiti Bolivia Argentina Brasil Chile Costa Rica Cuba
Uruguay: very advanced
Colombia Ecuador El Salvador Honduras Mexico Nicaragua Panama Paraguay Peru Dominican Rep. Venezuela WHO 2008
Pros and Cons of the LADTR
n
Cons:
¨ Voluntary reporting.
¨ Not all countries reported each year, not always with the same data
¨ In the case of México, country data are extrapolated from the Jalisco
and, since 2007, Morelos Registry ( 8,61 million inhabitants)
¨ The number of patients living with a functioning kidney graft many
times is an estimation
n Pros:
¨ Continuity along the time since 1991
¨ It has
n Contributed to the knowledge of RRT epidemiology in LA
n Helped to the development of National Registries.
n Let comparisons among countries and with other registries,
n Establish the trends in the treatment of extreme CKD in LA.
¨ Today, Latin American data can be consulted in international
LADTR 1992-2008. Renal Replament treatment Prevalence, all modalities
SLANH 2006 119 129 131 147 173 174 199 258 278 335 352 387 424 443 478 473 522 568 0 100 200 300 400 500 600 700 Pr ev al enc e (pm p) year
Prevalence RRT rates IRCT: Puerto Rico 1170, Uruguay 1079, Chile 1034 (in pmp)
Prevalence rates: dialysis 455 pmp (HD: 337 PD 118); functioning kidney graft: 105 pmp
Total number of patients: 313,525
HD: 189,137 ptes (59%)
PD: 65,824 ptes (21%)
Functioning graft: 58,564 ptes (19%)
HD Centers : 2155, 1/118 dialysis pts 1/258,695 inhabitantes
Tx Centers 502: 1c/508 dialysis patients 1 c/ 1,110,534 inhabitantes
Prevalent Patients number (in miles), by year
0,00 20,00 40,00 60,00 80,00 100,00 120,00 140,00 160,00 180,00 200,00 1992 1993 1994 1995 96/9 7 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Pa ti en ts H D D P tx
-100 100 300 500 700 900 1100 1300 Puerto Rico 2 Uruguay Chile Argentina * México Brasil El Salvador Colombia * Venezuela 2007 Panamá Cuba Costa Rica Ecuador Guatemala Perú * Honduras Rep Dominicana Bolivia 2007 Paraguay 2006 Nicaragua Latin America 562 pmp
Broad variability in RRT prevalence rate among
countries
Epidemiologic transition stage Countries Prev. Rates pmp Stage 1 Incipient Stage 2 Moderate Guatemala Bolivia RRT HD DP FG 215 104 84 27 Stage 3 Full Colombia Ecuador El Salvador Honduras Mexico Nicaragua Panama Paraguay-Peru Dominican Rep. Venezuela RRT HD DP FG 495 244 207 43 Stage 4
Adanced & very advanced Argentina Brazil-Chile Costa Rica Cuba-Uruguay P.Rico RRT HD DP FG 676.5 463 39 175
Income Countries Prev. Rates pmp Low income < $ 995 Lower Middle income $996-3945 Ecuador El Salvador Guatemala Honduras Nicaragua Paraguay RRT HD DP FG 251 160 91 23 Upper Middle income $ 3946-12195 Argentina Brazil-Chile Colombia Costa Rica Cuba- Mexico Panama-Peru Dominican Rep Uruguay Venezuela RRT HD DP FG 560 360 124 116 High income > $12195 Puerto Rico RRT HD DP FG 1170 997 80 92
GNI vs Prevalence rate (excluded PR) 2008
Prevalence rate & age (Argentina, Brazil, Chile, Cuba, Ecuador,
Panamá, Perú, Puerto Rico, Uruguay, 56% LA Population) 2007 Rate # Pa+ents <20 20.4 2299 20-59 473.8 79785 >60 1787.4 56856 138940 Correlations (2008) p value GNI 0.000 Health expenditure in $ 0.001 % inhabitantes > 65 years 0.000 Life expectancy 0.017 % urban population 0.000
RRT incidence rates (pmp)
data 2007
2007-2008: Incidence was reported by14 countries (91% LA
population). Number of patients registered: 2007-08 100968 (~40% of prevalent patients). 0 50 100 150 200 250 300 350 400 450 Mexi co Puer to R ico Hond uras Chile Urug uay Brazi l Colo mbi a Arge ntin a Vene zuelaCUBA Ecua dor Boliv ia Peru LA 2 008 LA 2 007
0,00 50,00 100,00 150,00 200,00 250,00 300,00 350,00 400,00 2002 2003 2004 2005 2006 2007 2008 2009 2010 Chile Puerto Rico Uruguay Argentina Latin America
Stabilization incidence rate: Puerto Rico, Chile
& Argentina
México 430 pmp PR 334 pmp Chile 172 pmp Uruguay 165 pmp LA 208 pmp United States: 362 pmp Portugal 232 pmp Italia 150.9 Spain 128 pmp Japan 288 pmpTx registered in 2009: 9724 (19 countries) Total registered 1987-2009: 136567
Nicaragua, Honduras & El Salvador: only living donors % of deceased donor: stable around 50%
LADKTR: Transplantation rate
(pmp): 1987-2009
Trasplantation rates, by country
year 2009
0 16 32 48 Argentina Bolivia Brazil Chile Colombia C. Rica Cuba Ecuador El Salvador Guatemala Honduras Mexico Nicaragua Panama Paraguay Peru P.Rico R. Uruguay Venezuela LADouble transplants performed in 7 countries: Argentina, Brazil, Colombia, Cuba, Perú, Uruguay & Mexico.
¿Why so many variations
among countries?
• Still countries with no full RRT coverage
• Diferences in stages of epidemiological transition, life
expectancy, % of older people, GNI, urbanization, etc.
• RRT begun at different times in the LA countries. • 1947, 1st dialysis in Brazil
• 1957, 1st transplant in Argentina. • 2000: 1st dialysis in Nicaragua.
• Countries, even now, which do not have laws
Conclusions
n RRT: available in all countries, yet not to all pts who
need it
n Higher prevalence rates: Puerto Rico, Uruguay and
Chile
n Highest incidence rates: Mexico and Puerto Rico
n RRT Prevalence rates correlates directly with GNI, % of
population over 65 años, life expectancy, health expenditure in constant dollars and % urban
population.
n Kidney Transplantation rates increasing, but will not
resolve the growing increase in prevalence.
n Prevention of risk factors and early detection and
treatment of CKD continues been the solution to reduce the increasing RRT prevalence
Carlota Gonzalez Bedat Sergio Marinovich
Guillermo García García Tomaso Bachichio
Sdenka Maury Fernadez Jocemir Lugon
Hugo Poblete Badal Rafael Gomez
Fabio Hernandez Miguel Almaguer Nelly Freyre
Ricardo Leiva Merino Jorge Luna Guerra Gaspar Rodriguez Cesar Cuero
Carlos Pereda
Sandra Ivelize Rodriguez
