Population 519,200,000

Population > 65 years old 5.6%

Mean GNI 3,550 dollars per capita

Life expectancy 70.5 years

Human development index 0.777

Population increase 1.5% annually

Latin America

End stage renal disease prevention strategies in Latin America

B.Rodriguez-Iturbe, E, Bellorin-Font

Population: 519,200,000

GNI: 3550 dollars per capitaLife expectancy: 70.5 years

Human development index; 0.777Increase population; 1.5% annually

Population > 65 years old: 5.6%

END STAGE RENAL DISEASE AND PREVENTION STRATEGIES

IN LATIN AMERICA

Latin America

GDP and Population in LA

Mex

ico

Brasi

l

Argen

tina

Venez

uelaChile

Colom

biaPer

u

Rep D

omin

Guatem

aia

Uruguay

Ecuad

or

Costa

Rica

Panam

a

Trinid

ad/T

obago

Jam

aica

Bolivia

Parag

uay

Honduras

Nicar

agua

Beliz

e

Guyana

0

50

100

150

200

250

300

350

400

450

500

550

600

650

GDP(US$ billions Population (millions)

0

25

50

75

100

125

150

175

Life and healthy expectancy at birth in countries of South and Central America and Caribbean

40

50

60

70

80

Industrialized countries (Mean 95%CI)

Life expectancyat birth

Healthy Lifeexpectancy

Yea

rs

Annual GDP/capita vs Life ExpectancySouth and Central America and Caribbean

1000 10000 10000060

65

70

75

80

85

26401

Developed countries(Mean 95%CI)

Annual GDP/capita

Lif

e ex

pec

tan

cy (

year

s)

MD+Nurses vs Life Expectancy

South and Central America and Caribbean

0 250 500 750 1000 1250 150060

65

70

75

80

85

LA countries Industrialized nationsMean 95%CI

MD+Nurses/100.000 inhabitants

Lif

e ex

pec

tan

cy (

year

s)

Annual expenditure in health per capita

0 100 200 300 400 500 600 700 800 900 1000 1100

ArgentinaUruguay

ChileBrasil

ColombiaMexico

Costa RicaPanama

Trinidad TobagoParaguay

El SalvadorRep.Domin

GrenadaVenezuela

CubaPeru

JamaicaGuyana

GuatemalaHonduras

BoliviaEcuador

HaitiPrivateGovernment

US dollars/year/capita

Life Expectancy vs % GDP in HealthSouth and Central America and Caribbean

0 1 2 3 4 5 6 7 8 9 10 11 1260

65

70

75

80

85

Developed countries (Mean 95%CI)

% GDP in Health

Lif

e E

xp

ec

tan

cy

(ye

ars

)

Annual expenditure in health per capita

0 500 1000 1500 2000 2500 3000

ArgentinaUruguay

ChileBrasil

ColombiaMexico

Costa RicaPanama

Trinidad TobagoParaguay

El SalvadorRep.Domin

GrenadaVenezuela

CubaPeru

JamaicaGuyana

GuatemalaHonduras

BoliviaEcuador

HaitiPrivateGovernment

Industrialized nations(Mean 95%CI)

US dollars/year/capita

SLANH: 20 countries, population

509,565,697

Report 2000-2001: Dialysis: 14/20 countries (90% of LA population)Kidney Transplants from 18/20 countries, (96 % of LA population)

LA Registry of Dialysis and Transplantation Reports: 1991-2001

17.4

2.4

19.5

2.5

22.2

2.7

24.7

2.5

29.0

4.3

33.3

4.3

37.6

4.3

43.1

5.5

49

6.4

56

6.5

0

10

20

30

40

50

60

70

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Total since 1992 During the year

Transplants(x 1000)

55% Living donor (except Argentina, Chile, Colombia, Cuba, Puerto Rico, Uruguay and Venezuela)

335 349

129 131 147173 199174

258278

R2 = 0,9383

0

100

200

300

400

500

Patients pmp

Latin American Registrty:

Treatment of ESRD, all modalities, 1992-2001

(Courtesy Dr. Cusumano 2003)

461

275

528

185

32

111

122

124

305

61

141

843

689

224

110

79

32

122

72

14

30,4

72

14

13

146

89

44

135

0 200 400 600 800 1000 1200

Argentina

Brazil

Chile

Colombia

Costa Rica

Cuba

Ecuador

Guatemala

Mexico

Paraguay

Peru

Puerto Rico

Uruguay

Venezuela

Dialysis

Transplantation

Latin America RegistryPrevalence all treatments pmp 31/12/01

(Courtesy Dr. Cusumano 2003)

Prevalence inLatin America

349 pmp

447

246

506

99

26

102

109

51

43

61

122

733

652

204

14

29

22

85

6

9

14

73

262

18

110

37

20

0 100 200 300 400 500 600 700 800 900

Argentina

Brasil

Chile

Colombia

Costa Rica

Cuba

Ecuador

Guatemala

Mexico

Paraguay

Peru

Puerto Rico

Uruguay

Venezuela

HD DP

Population: 461913654

Dialysis Prevalence in Latin America

277.1 pmpHD 197 DP 80.1

Number of patients (14 countries, 90% LA pop.): HDC 92767; DP 37727 (México 86%), Living with functioning kidney Tx: 34044

LATIN AMERICAN REGISTRY Prevalence by dialysis modality, pmp, 31/12/01

0

50

100

150

200

250

300P

atie

nts

pm

p

Dialysis incidence in LA 91.4 pmp

Theoretical Incidence: 130 ppmUnmet demand 40 ppmNot getting dialysis: 18842 ptsOnly 1/14 countries over the theoretical incidence

Diabetic nephropathy:SLANH 2001: 33% USRDS 2000: 45%Australia 2001: 25% New Zealand: 37% EDTA-ERA 2000: 22.4% Japan 2000: 36.6%

Etiology ESRD

Diabetic nephropathy

33%

Hypertension32%

Chronic GN9%

Not defined11%

Others15%

R2 = 0,9265

0

20

40

60

1991 1992 1993 1994/95 1996/97 1998/99 2000 2001 2005

without PR

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

The cost of diabetes in Latin America and the Caribbean. Bull World Health Org 81:20-23, 2003

Direct Health costs of Diabetes in LA

0 250 500 750 1000

Argentina

Uruguay

Chile

Panama

Venezuela

Costa Rica

Brazil

Mexico

Colombia

Paraguay

Trinidad

El Salvador

Jamaica

Cuba

Peru

Domin Rep

Guatemala

Ecuador

Honduras

Bolivia

Nicaragua

Haiti

Per capita annualhealth expenditure

Per capita annualdirect costs ofdiabetes

US Dollars

Excess cost of diabetes114 - 2517%

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

Venezuela 32.4 47 37 8.5

Cuba prevalence ~ 30% (50% >60 años) known in 75% (**)

Hypertension In Latin America (*)

(*) 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

0.0 2.5 5.0 7.5 10.0 12.5 15.0

ChileParaguay

Costa RicaArgentina

MexicoUruguay

CubaHondurasPanamá

VenezuelaColombia

JamaicaTrinidad

BrasilEl Salvador

Peru Rep Dominicana

BoliviaEcuador

GuatemalaHaiti

NIcaraguamean LA

mean industrializedcountries

% live births with <2500g//utal.org/segsocial/index.htm 1998

Prevention Strategies:

• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention

• Reduce cost of medications with the potential to retard progression of ESRD

• Free access to full text publications to strengthen academic nephrology.

• Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)

• Support and advise in the design of epidemiologic studies

COMGAN hassupported events in allLA countries

• Invited speakers• Simposia• Side visits• Fact finding trips

• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention

“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 and advise in the design of epidemiologic studies

Conjunto deAcciones para laReducciónMultifactorial de lasEnfermedadesNo transmisibles

PAHO

Rafael Burgos & Santos Delpine

Sustenable and tenable renal health model. A

Latin American proposal

• Support efforts to engage the government in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)

Prevention Strategies:

• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention

• Reduce cost of medications with the potential to retard progression of ESRD

• Free access to full text publications to strengthen academic nephrology.

• Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)

• Support and advise in the design of epidemiologic studies

182.67 millions

33.35 millions 6.31 millions

190.91 millions

5.12 millions187.24 millions

World Total of Internet Users 605.6 million

Source: Jupitermedia CorporationNua Internet surveys, Sept 2002

Percent of population with Internet access

0 10 20 30 40 50 60

ChileUruguay

PeruTrinidad/Tobago

ArgentinaCosta Rica

BrasilGranada

VenezuelaJamaica

El SalvadorParaguay

Mexico Colombia

EcuadorDom Rep

PanamaGuatemala

GuyanaCuba

Bolivia Industrialized nations(Mean 95%CI)

% of population with Internet Access

Source: Nielsen/Net Ratings. Cyber Atlas September 2003

90% of users are profesionals

8/10 individuals with academic

positions have Internet access

(except Cuba)

0 1000 2000 3000 4000 5000

Mexico

Chile

Brazil

Venezuela

Argentina

Paraguay

Individual annual subscription to5 leading nephrology journals (*)

Annual membership to the5 corresponding societies( **)

(*) Alphabetically : Am J Kidney Dis, Am J Physiol Renal Physiol,J Am Soc Nephrol, Kidney Int, Nephrol Dial Transplant(**) subscription to the journal included

Basic Salary Associate Professor (Full time)in US dollars/month

Prevention Strategies:

• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention

• Reduce cost of medications with the potential to retard progression of ESRD

• Free access to full text publications to strengthen academic nephrology.

• Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)

• Support and advise in the design of epidemiologic studies

Source: www.uniceflac.org 2000/indicadores)

0 5 10 15 20 25 30 35 40 45 50 55

Guatemala

Honduras

Nicaragua

Ecuador

Panamá

Brasil

Rep Dominicana

Costa Rica

Chile

México

Venezuela

Colombia

% of the population that lives on less than 1 USA $ per day

(International Poverty Line)

POPULATION BELOW POVERTY LINE IN LATIN AMERICA

POPULATION WITHOUT ADEQUATE SANITATION IN LATIN AMERICA

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)

In Canada and USA 0.16%

0 5 10 15 20 25 30 35 40 45

EcuadorBolivia

ParaguayEl Salvador

VenezuelaHonduras

Mexico Perú

NicaraguaGuatemalaColombia Argentina

BrasilPanamá

Chile Costa Rica

Cuba Uruguay

Mean LA

% Population without adequate sanitation

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

POPULATION WITHOUT POTABLE WATER IN LATIN AMERICA

0 10 20 30 40 50 60

ParaguayEL Salvador

NIcaraguaEcuador

BoliviaParú

ArgentinaGuatemalaHondurasVenezuela

MéxicoPanamá

BrasilColombia

Cuba Chile

Costa Rica Uruguay

Mean LA

% of the population without potable water

3.7

5.25.4 5.7

6.9 5.97.4

6.4

9.810.5

9.510.2 10.8

13.613.7

0

3

6

9

12

15

Tran

spla

nts

pmp

87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01

Leading 10 selected risk factors as percentage causes of disease burden measured in DALYs

WHO. WHR 2002

(LA nations)