BURDEN OF DISEASE PREVALENCE AND INCIDENCE OF RENAL DISEASE (ESRD) IN LATIN AMERICA

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Alfonso Ramírez Barbero
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1 BURDEN OF DISEASE PREVALENCE AND INCIDENCE OF RENAL DISEASE (ESRD) IN LATIN AMERICA GUILLERMO GARCÍA GARCÍA on behalf of

2 MAIN POINTS Demographic and socioeconomic characteristics of Latin America Latin America Dialysis and Renal Transplant Registry (LADTR) outcomes RRT prevalence & incidence in all modalities renal transplants correlation with socioeconomic variables

Registry (LADTR) outcomes RRT prevalence & incidence in all

3 DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS

4 LATIN AMERICA Extended from Río Bravo (México) in the North to Tierra del Fuego (Argentina) in the South Share the language: Spanish or Portuguese and a wide ethnic diversity Surface area: millions km 2 ( 13.5% of emerging surface of the planet) Population: * Annual population growth rate : 1,1% * Urban population: 79.3% * Life expectancy at birth: 74 years* Older than 65 years : 7% * Gross national income: U$D U$ 5,477 billions * Gross national income per capita: U$D $ 9314 * Literacy rate: 93% male y 92% female * Human development index: ** * **

000 * Annual population growth rate 2000-2012: 1,1% * Urban population: 79.

5 LATIN AMERICA SIGNIFICANT IMPROVEMENT OF SOCIOECONOMICS INDICATORS Life expectancy at birth: 68 to 74 years ( ) GNI: U$D 2784 to U$D 9314 ( ) Nicaragua & Haiti are still in the group of low income (< 1200 U$D) 5 countries are in the group of lower middle income ( ) 7 countries are in the group of upper middle income ( ) 6 countries are in the group of high income ( ) only Puerto Rico is in the group of very high income % of population living below poverty line ( ) from 22.4 to10.4% % of population living below absolute poverty line ( ) from 12.0 to 5.5% mean health expenditure per capita U$D 713 HDI: a 0.741

income (3580-7980) 6 countries are in the group of high income (7980-23610) only Puerto Rico is in the group of very high income % of population living below poverty

6 LIFE EXPECTANCY AT BIRTH BOTH SEXES 2012

7 HUMAN DEVELOPMENT INDEX 2012

8 INEQUALITY 2013

9 WEAKNESSES voluntary reporting LADRTR SWOT ANALYSIS wide variability in the data consistency until 2010 Mexico data were extrapolated from state Registries (Morelos & Guadalajara) the number of patients living with a functioning kidney graft many times is an estimation STRENGHTS continuity along the time since 1991 contributed to the development of National Registries allowed to make comparisons among different countries and with other registries established the trends in the treatment of CKD in LA

times is an estimation STRENGHTS continuity along the time since 1991 contributed to the development of National Registries

YEAR 1992 DATA FROM 18 COUNTRIES TOTAL NUMBER OF RRT PATIENTS: 53.

291 Costa Rica Bolivia Honduras Rep Dominicana Panamá Nicaragua Cuba

10 YEAR 1992 DATA FROM 18 COUNTRIES TOTAL NUMBER OF RRT PATIENTS: HD: PD: FKG: Costa Rica Bolivia Honduras Rep Dominicana Panamá Nicaragua Cuba Guatemala Uruguay Ecuador Brasil El Salvador Paraguay Colombia Perú Puerto Rico Chile Venezuela México Argentina

YEAR 2011 DATA FROM 20 COUNTRIES TOTAL NUMBER OF RRT PATIENTS 358.978 HD: 224.764 PD: 73.761 FKG: 60.

El Salvador Puerto Rico Ecuador Perú Venezuela Chile If this extrapolation was correct, the number of

11 YEAR 2011 DATA FROM 20 COUNTRIES TOTAL NUMBER OF RRT PATIENTS HD: PD: FKG: Rep Dominicana Costa Rica Panamá Bolivia Guatemala Honduras Brasil Paraguay Nicaragua Cuba Uruguay El Salvador Puerto Rico Ecuador Perú Venezuela Chile If this extrapolation was correct, the number of RRT patients of Mexico would be about 1/3 of the amount of Latin American RRT patients México Colombia Argentina

12 OUTCOMES

13 PATIENTS PMP RRT PREVALENCE IN LATIN AMERICA ( ) YEAR

119 129 131 147 173 174 199 258 278 335 352

14 PATIENTS PMP RRT PREVALENCE IN LATIN AMERICA ( ) (preliminary data) YEAR

200 100 119 129 131 147 173 174 199 258 278 335 352

15 RRT PREVALENCE IN LATIN AMERICA BY COUNTRY YEAR 2012 Puerto Rico Jalisco Chile Uruguay Argentina Brasil Colombia El Salvador Venezuela Panamá Ecuador Perú Costa Rica Cuba Bolivia Rep Dominicana Honduras Paraguay Guatemala Nicaragua 663,2 564,4 556,1 477,7 472,7 456,4 351,4 329,8 326,8 222,4 185, ,1 134,5 63,9 833,1 1038,3 1239,4 1427,6 1740, PMP

Honduras Paraguay Guatemala Nicaragua 663,2 564,4 556,1 477,7 472,7 456,4 351,4 329,8 326,8 222,4

1992 1993 1994 1995 96/97 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Nº OF PATIENTS EVOLUTION OF

16 / Nº OF PATIENTS EVOLUTION OF NUMBER OF RRT PATIENTS IN LATIN AMERICA BY TREATAMENT MODALITY ( ) HD DP KFG YEAR

17 RRT PREVALENCE IN LATIN AMERICA. YEAR 2012 LATIN AMERICA Nicaragua Guatemala Paraguay Honduras Rep Dominicana Bolivia Cuba Costa Rica Perú Ecuador Panamá Venezuela El Salvador Colombia * Brasil Argentina * Uruguay Chile Jalisco Puerto Rico 601 PMP ẋ = 569 PMP HD PD KFG PATIENTS PMP

Costa Rica Perú Ecuador Panamá Venezuela El Salvador Colombia * Brasil Argentina * Uruguay

18 Honduras Ecuador Paraguay Chile Rep Dominicana Bolivia Nicaragua Argentina * Cuba Venezuela Puerto Rico Perú Brasil Panamá Uruguay Guatemala Colombia * Jalisco El Salvador Costa Rica PREVALENCE OF RRT IN LATIN AMERICA. YEAR 2012 HD PD KFG 0% 20% 40% 60% 80% 100% PATIENTS %

Guatemala Colombia * Jalisco El Salvador Costa Rica PREVALENCE OF

19 PREVALENCE OF PD IN LATIN AMERICA. YEAR 2012 Paraguay Cuba Nicaragua Rep Dominicana Honduras Bolivia Costa Rica Guatemala Argentina * Ecuador Perú Brasil Chile Venezuela Uruguay Panamá Puerto Rico Colombia * El Salvador Jalisco PATIENTS PMP

Guatemala Argentina * Ecuador Perú Brasil Chile Venezuela Uruguay Panamá Puerto

20 RRT INCIDENCE IN LATIN AMERICA. YEAR 2012 Honduras Ecuador Chile Brasil Argentina Uruguay Cuba Bolivia Colombia Nicaragua Perú Jalisco Paraguay Guatemala ẋ = 121 PMP PATIENTS PMP

21 RENAL TRANSPLANTATION

22 PATIENTS PMP RENAL TRANSPLANTATION RATE IN LATIN AMERICA ,5 13,6 13,7 13,7 13,2 18, ,2 16,9 19,5 19,1 19, ,7 5,2 5,4 5,7 6,9 5,9 7,4 6,4 9,8 10,5 9,5 10,2 10,8 0 YEAR

23 GNI PMP ATHLAS METHOD SOCIO-ECONOMIC INDEXES AND ESRD PREVALENCE R2=0,835 NON PARAMETRICS CORRELATIONS YEAR 2010 GROSS NATIONAL INCOME GROSS NATIONAL INCOME PER CAPITA LIFE EXPECTANCY AT BIRTH p TRR pmp NEPHROLOGISTS PMP 0.659

24 ARGENTINA: Sergio Marinovich BOLIVIA: Sdenka Maury Fernández José Luis Valencia BRASIL: Jocemir R. Lugon CHILE: Hugo Poblete Badal Ana Mireya Ortiz Susana Elgueta Miranda COLOMBIA: Rafael Gómez COSTA RICA: Manuel Cerdas Calderón Fabio Hernández CUBA: Miguel Almaguer López ECUADOR: Nelly Freire EL SALVADOR: Ricardo Leiva Merino GUATEMALA: Jorge Luna Guerra HONDURAS: Gaspar Rodríguez MEXICO: Guillermo García García Tommaso Bochicchio NICARAGUA : Nubia Cano ncanoe@hotmail.com Norman Iron dir-regulacion@minsa.gob.ni Danilo Rivas Miranda d.rivasmiranda@yahoo.es PANAMÁ: Carlos Viggiano caviggianov@yahoo.com PARAGUAY: Darío Cuevas dcuevasb@gmail.com PERÚ: Carlos Tapia cartazer01@yahoo.com PUERTO RICO: José L. Cangiano jlcangiano@yahoo.com REP. DOMINICANA: Sandra Rodríguez sandrairodriguez@hotmail.com URUGUAY: Maria Carlota González Bedat ereude@netgate.com.uy VENEZUELA: Haideé González psrenal@mpps.gob.ve SOC. DE T LA Y CARIBE: Valter Duro Garcia vdurogarcia@uol.com.br REGISTRO DE DONACIÓN Y TRASPLANTE DE LA Y CARIBE registro@slanh.org

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