END STAGE RENAL DISEASE AND PREVENTION STRATEGIES IN

END STAGE RENAL DISEASE AND PREVENTION STRATEGIES IN LATIN AMERICA Latin America Population: 519, 200, 000 GNI: 3550 dollars per capita Life expectancy: 70. 5 years Human development index; 0. 777 Increase population; 1. 5% annually Population > 65 years old: 5. 6%

ex ic o B A ra rg s Ve en il ne tin zu a el a C C h ol il om e bi a R ep Pe r G Do u ua m te in U ma ru ia g Ec ua C ua y os d ta or Tr R in id Pa ica ad na /T m ob a Ja ag m o a B ica ol Pa iv r ia H agu on a N du y ic ra ar s ag u B a el G ize uy an a M GDP and Population in LA GDP(US$ billions Population (millions) 650 600 550 500 450 400 350 300 250 200 150 100 50 0 175 150 125 100 75 50 25 0

Life and healthy expectancy at birth in countries of South and Central America and Caribbean 80 Years 70 60 50 40 Life expectancy at birth Healthy Life expectancy Industrialized countries (Mean ± 95%CI)

Life expectancy (years) Annual GDP/capita vs Life Expectancy South and Central America and Caribbean 85 80 75 70 65 60 10000 26401 Annual GDP/capita Developed countries(Mean ± 95%CI) 100000

Life expectancy (years) MD+Nurses vs Life Expectancy South and Central America and Caribbean 85 80 75 70 65 60 0 250 500 750 1000 1250 1500 MD+Nurses/100. 000 inhabitants LA countries Industrialized nations Mean ± 95%CI

Life Expectancy (years) Life Expectancy vs % GDP in Health South and Central America and Caribbean 85 80 75 70 65 60 0 1 2 3 4 5 6 7 8 9 10 11 12 % GDP in Health Developed countries (Mean ± 95%CI)

Annual expenditure in health per capita Haiti Ecuador Bolivia Honduras Guatemala Guyana Jamaica Peru Cuba Venezuela Grenada Rep. Domin El Salvador Paraguay Trinidad Tobago Panama Costa Rica Mexico Colombia Brasil Chile Uruguay Argentina Private Government Industrialized nations (Mean ± 95%CI) 0 500 1000 1500 2000 2500 US dollars/year/capita 3000

SLANH: 20 countries, population 509, 565, 697 LA Registry of Dialysis and Transplantation Reports: 1991 -2001 Report 2000 -2001: Dialysis: 14/20 countries (90% of LA population) Kidney Transplants from 18/20 countries, (96 % of LA population)

Transplants (x 1000) Total since 1992 70 During the year 56 60 49 50 43. 1 37. 6 40 30 20 10 17. 4 2. 4 19. 5 22. 2 2. 7 33. 3 29. 0 24. 7 2. 5 4. 3 5. 5 6. 4 6. 5 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 55% Living donor (except Argentina, Chile, Colombia, Cuba, Puerto Rico, Uruguay and Venezuela)

Latin American Registrty: Treatment of ESRD, all modalities, 1992 -2001 (Courtesy Dr. Cusumano 2003)

Latin America Registry Prevalence all treatments pmp 31/12/01 Argentina 461 Brazil 275 110 79 Chile 528 Colombia 185 Costa Rica 32 135 32 Dialysis Transplantation 122 Cuba 111 Ecuador 122 14 Guatemala 124 30, 4 72 305 Mexico Prevalence in Latin America 349 pmp 72 Paraguay 61 14 Peru 141 13 Puerto Rico 843 Uruguay Venezuela 0 146 689 224 89 44 200 400 600 800 1000 (Courtesy Dr. Cusumano 2003) 1200

LATIN AMERICAN REGISTRY Prevalence by dialysis modality, pmp, 31/12/01 Population: 461913654 Dialysis Prevalence in Latin America 277. 1 pmp HD 197 DP 80. 1 Number of patients (14 countries, 90% LA pop. ): HDC 92767; DP 37727 (México 86%), Living with functioning kidney Tx: 34044

Dialysis incidence in LA 91. 4 pmp Theoretical Incidence: 130 ppm Unmet demand 40 ppm Not getting dialysis: 18842 pts Only 1/14 countries over theoretical incidence

Etiology ESRD Others 15% Diabetic nephropathy 33% Not defined 11% Chronic GN 9% Hypertension 32% Diabetic nephropathy: SLANH 2001: 33% Australia 2001: 25% EDTA-ERA 2000: 22. 4% USRDS 2000: 45% New Zealand: 37% Japan 2000: 36. 6%

Latin American Registry: Progressive increase of diabetic patients (1991 -2001) % n= 18486

Some risk factors of ESRD in Latin America • Diabetes • Hypertension • Low birth weight

Direct Health costs of Diabetes in LA Haiti Nicaragua Bolivia Honduras Ecuador Guatemala Domin Rep Peru Cuba Jamaica El Salvador Trinidad Paraguay Colombia Mexico Brazil Costa Rica Venezuela Panama Chile Uruguay Argentina Per capita annual direct costs of diabetes Per capita annual health expenditure Excess cost of diabetes 114 - 2517% The cost of diabetes in Latin America and the Caribbean. Bull World Health Org 81: 20 -23, 2003 0 250 500 750 US Dollars 1000

Hypertension In Latin America (*) Prevalence (%) Known (%) Treated (%) Controlled (%) Argentina 28. 1 54 42 14. 3 Brazil 26. 8 50 30 10 Chile 22. 8 43 26. 1 8. 2 Ecuador 28. 7 41 23 6. 7 Mexico 30. 5 28 38 22 Paraguay 30. 5 33. 5 18. 3 7. 8 Peru 22 40 20 10 Uruguay 33 68 42 11 32. 4 47 37 8. 5 Venezuela Cuba prevalence ~ 30% (50% >60 años) known in 75% (**) (*) Consenso Latinoamericano sobre hipetensión arterial. J Hypertens (Edición en Español) 6: 1 -27, 2001 (**) De la Osa JA. Hipertension arterial. // consulta. cuba. cu; Salazar J, Aguilar J. Prevalencia de la hipetensión arterial en un consultorio médico de familia. www. informed. sld. cu/revistas/san (°) Velazquez-Monroy et al. Arch Cardiol de México. 73: 62 -77, 2003

Low birth weight in LA mean industrialized countries NIcaragua Haiti Guatemala Ecuador Bolivia Rep Dominicana Peru El Salvador Brasil Trinidad Jamaica Colombia Venezuela Panamá Honduras Cuba Uruguay Mexico Argentina Costa Rica Paraguay Chile 0. 0 2. 5 5. 0 7. 5 mean LA 10. 0 12. 5 % live births with <2500 g //utal. org/segsocial/index. htm 1998 15. 0

Prevention Strategies: • To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention • Support and advise in the design of epidemiologic studies • Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) • Free access to full text publications to strengthen academic nephrology. • Reduce cost of medications with the potential to retard progression of ESRD

COMGAN has supported events in all LA countries • Invited speakers • Simposia • Side visits • Fact finding trips • To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention

• Support and advise in the design of epidemiologic studies “Only 48% of the studies published between 1966 and 2000 to estimate the prevalence of hypertension in Latin America meet a critical thereshold to be useful for surveillance purposes” Ordúñez P, Silva LC, Paz M, Robles S. Prevalence estimates for hypertension in Latin America and the Caribbean: Are they useful for surveillance? Pan Am J Public Health 10: 226 -230, 2001

• Support efforts to engage the government in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) Conjunto de Acciones para la Reducción Multifactorial de las Enfermedades No transmisibles PAHO Sustenable and tenable renal health model. A Latin American proposal Rafael Burgos & Santos Delpine

Prevention Strategies: • To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention • Support and advise in the design of epidemiologic studies • Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) • Free access to full text publications to strengthen academic nephrology. • Reduce cost of medications with the potential to retard progression of ESRD

World Total of Internet Users 605. 6 million 182. 67 millions 190. 91 millions 5. 12 millions 33. 35 millions 187. 24 millions 6. 31 millions Source: Jupitermedia Corporation. Nua Internet surveys, Sept 2002

Percent of population with Internet access Bolivia Cuba Guyana Guatemala Panama Dom Rep 90% of users Ecuador are profesionals Colombia Mexico Paraguay 8/10 individuals El Salvador Jamaica with academic Venezuela positions Granada Brasil have Internet access Rica (except Cuba) Costa Argentina Trinidad/Tobago Peru Uruguay Chile Industrialized nations (Mean ± 95%CI) 0 10 20 30 40 50 60 % of population with Internet Access Source: Nielsen/Net Ratings. Cyber Atlas September 2003

Prevention Strategies: • To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention • Support and advise in the design of epidemiologic studies • Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) • Free access to full text publications to strengthen academic nephrology. • Reduce cost of medications with the potential to retard progression of ESRD

POPULATION BELOW POVERTY LINE IN LATIN AMERICA % of the population that lives on less than 1 USA $ per day (International Poverty Line) Source: www. uniceflac. org 2000/indicadores)

POPULATION WITHOUT ADEQUATE SANITATION IN LATIN AMERICA In Canada and USA 0. 16% In Latin América/Caribbean 104. 316. 814 inhabitants (21. 9% of the total population) do not have adequate sanitation services. (Cidutal Estadísticas Abril 15, 2003)

POPULATION WITHOUT POTABLE WATER IN LATIN AMERICA Canada, USA) = 0. 02% In Latin América/Caribbean 72. 968. 187 inhabitants (15. 3% of the total population) do not have access to drinkable water. (Cidutal Estadísticas April 15, 2003

(LA nations) WHO. WHR 2002 Leading 10 selected risk factors as percentage causes of disease burden measured in DALYs