Transcript Document

End stage renal disease prevention
strategies in Latin America
B.Rodriguez-Iturbe, E, Bellorin-Font
Latin America
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
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%
GDP and Population in LA
GDP(US$ billions
650
600
550
500
450
400
350
300
250
200
150
100
50
0
Population (millions)
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
1000
10000
26401
Annual GDP/capita
Developed countries(Mean  95%CI)
100000
MD+Nurses vs Life Expectancy
Life expectancy (years)
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
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
0
100 200 300 400 500 600 700 800 900 1000 1100
US dollars/year/capita
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
During the year
70
56
60
49
50
43.1
37.6
40
33.3
29.0
30
20
10
17.4
2.4
19.5
2.5
22.2
2.7
24.7
2.5
4.3
4.3
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
Patients pmp
500
R2 = 0,9383
400
258
300
200
129 131 147
173 174
278
335 349
199
100
0
2 93 94 95 96 97 98 99 00 01
9
19 19 19 19 19 19 19 19 20 20
2
5
0
0
(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
146
689
Venezuela
224
0
89
44
200
400
600
800
1000
(Courtesy Dr. Cusumano 2003)
1200
LATIN AMERICAN REGISTRY
Prevalence by dialysis modality, pmp, 31/12/01
447
Argentina
246
Brasil
14
Population: 461913654
29
506
Chile
99
Colombia
22
85
HD
Costa Rica 266
Cuba
102
9
Ecuador
109
14
Guatemala
51
Mexico
43
Dialysis Prevalence in Latin
America
277.1 pmp
HD 197 DP 80.1
73
262
61
Paraguay
122
Peru
DP
18
Puerto Rico
733
110
652
Uruguay
Venezuela
0
204
20
100
200
300
37
400
500
600
700
800
Number of patients (14 countries, 90% LA pop.): HDC 92767; DP 37727
(México 86%), Living with functioning kidney Tx: 34044
900
Dialysis incidence in LA 91.4 pmp
300
200
150
100
50
Gu CR
ate
ma
la
Pa
rag
ua
y
Ec
La
ua
d
tin
Am o r
e ri
ca
0
PR
Ch
i
Ur le
ug
ua
y
Br
azi
l
M
ex
Co ico
lom
bi
Ar
ge a
nti
na
Cu
ba
Ve
ne
zue
la
Pe
ru
Patients pmp
250
Theoretical Incidence: 130 ppm
Unmet demand 40 ppm
Not getting dialysis: 18842 pts
Only 1/14 countries over the 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)
%
60
n= 18486
without PR
R2 = 0,9265
40
20
0
1991
1992
1993 1994/95 1996/97 1998/99 2000
2001
2005
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
Venezuela
32.4
47
37
8.5
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
mean LA
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
10.0
12.5
% live births with <2500g
//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 CorporationNua 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
Costa Rica
(except Cuba)
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
Individual annual subscription to
5 leading nephrology journals (*)
Annual membership to the
5 corresponding societies( **)
Paraguay
Argentina
Venezuela
Brazil
Chile
Mexico
0
1000
2000
3000
4000
5000
Basic Salary Associate Professor (Full time)
in US dollars/month
(*) Alphabetically : Am J Kidney Dis, Am J Physiol Renal Physiol,
J Am Soc Nephrol, Kidney Int, Nephrol Dial Transplant
(**) subscription to the journal included
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
Colombia
Venezuela
México
Chile
Costa Rica
Rep Dominicana
Brasil
Panamá
Ecuador
Nicaragua
Honduras
Guatemala
0
5
10 15 20 25 30 35 40 45 50 55
% 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
Uruguay
Cuba
Costa Rica
Chile
Panamá
Brasil
Argentina
Colombia
Guatemala
Nicaragua
Perú
Mexico
Honduras
Venezuela
El Salvador
Paraguay
Bolivia
Ecuador
In Canada and USA 0.16%
Mean LA
0
5
10
15
20
25
30
35
40
45
% Population without adequate sanitation
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
Uruguay
Costa Rica
Chile
Cuba
Colombia
Brasil
Panamá
México
Venezuela
Honduras
Guatemala
Argentina
Parú
Bolivia
Ecuador
NIcaragua
EL Salvador
Paraguay
Canada, USA) = 0.02%
Mean LA
0
10
20
30
40
50
60
% of the population without potable water
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
Kidney Transplantation (patients/million pop)
Transplants pmp
13.7
13.6
15
9.8
12
6.9
9
6
5.2
5.4
5.7
10.5
10.2
9.5
10.8
7.4
5.9
6.4
3.7
3
0
87
88
89
90
91
92
93
94
95
96
97
98
99
'00 '01
Year
SLANH Registry 2002
(LA nations)
WHO. WHR 2002
Leading 10 selected risk factors as
percentage causes of disease
burden measured in DALYs