International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America

  • Marina Wainstein
    Correspondence
    Correspondence: Marina Wainstein, National Health and Medical Research Council Chronic Kidney Disease Centre of Research Excellence and Chronic Kidney Disease in Queensland, Health Sciences Building, Level 8, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Brisbane, Queensland, 4006, Australia.
    Affiliations
    National Health and Medical Research Council Chronic Kidney Disease Centre of Research Excellence and Chronic Kidney Disease in Queensland, University of Queensland, Brisbane, Queensland, Australia

    Kidney Health Service, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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  • Author Footnotes
    31 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    Aminu K. Bello
    Footnotes
    31 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    Affiliations
    Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Vivekanand Jha
    Affiliations
    George Institute for Global Health, University of New South Wales, New Delhi, India

    School of Public Health, Imperial College, London, UK

    Manipal Academy of Higher Education, Manipal, India
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  • David C.H. Harris
    Affiliations
    Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
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  • Adeera Levin
    Affiliations
    Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Maria C. Gonzalez-Bedat
    Affiliations
    Executive Board of the Latin American Dialysis and Transplantation Registry, Montevideo, Uruguay
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  • Guillermo J. Rosa-Diez
    Affiliations
    Division of Nephrology, Department of Medicine, University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Executive Board of the Latin American Dialysis and Transplantation Registry, Sociedad Latinoamericana de Nefrología e Hipertensión, Buenos Aires, Argentina
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  • Alejandro Ferreiro Fuentes
    Affiliations
    Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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  • Laura Sola
    Affiliations
    Dialysis Unit, Centro Asistencial del Sindicato Médico del Uruguay Institución de Asistencia Médica Privada de Profesionales Sin Fines de Lucro, Montevideo, Uruguay
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  • Roberto Pecoits-Filho
    Affiliations
    School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil

    Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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  • Rolando Claure-Del Granado
    Affiliations
    Division of Nephrology, Department of Medicine, Hospital Obrero #2–Caja Nacional de Salud, Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia
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  • Magdalena Madero
    Affiliations
    Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
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  • Mohamed A. Osman
    Affiliations
    Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Syed Saad
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Deenaz Zaidi
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Meaghan Lunney
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Feng Ye
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Ivor J. Katz
    Affiliations
    Division of Medicine, Department of Renal Medicine, St George and Sutherland Hospitals, University of New South Wales, Sydney, New South Wales, Australia
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  • Maryam Khan
    Affiliations
    Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
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  • Sally Shrapnel
    Affiliations
    School of Mathematics and Physics, University of Queensland, Brisbane, Queensland, Australia
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  • Marcello Tonelli
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
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  • Ikechi G. Okpechi
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa

    Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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  • Author Footnotes
    31 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    David W. Johnson
    Footnotes
    31 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    Affiliations
    Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Translation Research Institute, Brisbane, Queensland, Australia
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  • on behalf of theISN Latin America Regional Board
  • Author Footnotes
    31 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
      Latin America is a region with a widely variable socioeconomic landscape, facing a surge in noncommunicable diseases, including chronic kidney disease and kidney failure, exposing significant limitations in the delivery of care. Despite region-wide efforts to explore and address these limitations, much uncertainty remains as to the capacity, accessibility, and quality of kidney failure care in Latin America. Through this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to report on these indicators to provide a comprehensive map of kidney failure care in the region. Survey responses were received from 18 (64.2%) countries, representing 93.8% of the total population in Latin America. The median prevalence and incidence of treated kidney failure in Latin America were 715 and 157 per million population, respectively, the latter being higher than the global median (142 per million population), with Puerto Rico, Mexico, and El Salvador experiencing much of this growing burden. In most countries, public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) care, with patients incurring at least 1% to 25% of out-of-pocket costs. In most countries, >90% of dialysis patients able to access kidney replacement therapy received hemodialysis (n = 11; 5 high income and 6 upper-middle income), and only a small minority began with peritoneal dialysis (1%–10% in 67% of countries; n = 12). Few countries had chronic kidney disease registries or targeted detection programs. There is a large variability in the availability, accessibility, and quality of kidney failure care in Latin America, which appears to be subject to individual countries’ funding structures, underreliance on cheap kidney replacement therapy, such as peritoneal dialysis, and limited chronic kidney disease surveillance and management initiatives.

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