La diálisis peritoneal en Centroamérica y el Caribe: estado actual, necesidades y propuestas

Abstract

Chronic kidney disease is a global issue and the prevalence of patients on renal replacement therapy (RRT) is constantly increasing. Many of our countries are of low/middle income and the common burden of diabetic and hypertensive patients is enhanced by the epidemic of Mesoamerican nephropathy. Considering this, the Central American and the Caribbean Association of Nephrology and Hypertension/Region 4 of the Latin American Society of Nephrology and Hypertension organized a series of meetings with the nephrology societies of Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic and Cuba, to assess the situation and generate proposals. On this paper we present the results of the meeting of peritoneal dialysis (PD), its current status as option of dialytic RRT, and proposals to improve it. In 2017 the official population of the 8 countries was 69,283,417 inhabitants and 27,170 patients were on dialytic RRT: 18,020 (66.3%) on haemodialysis and 9,150 (33.7%) on PD, although with noteworthy differences between countries. Regional prevalence of patients in dialytic RRT: 392.2 patients pmp. By country: El Salvador 677.2, Panamá 526.3, Nicaragua 512.5, Guatemala 400.4, Dominican Republic 359.4, Honduras 345.1, Cuba 276.1, Costa Rica 138.9 pmp. Regional prevalence of PD patients: 132.1 pmp. El Salvador (380.1), Guatemala (217.2) and Costa Rica (103.1) have the highest prevalence; Dominican Republic (85.7), Honduras (20.1) and Cuba (6.1) the lowest. In Nicaragua and El Salvador most patients in the public health system still use obsolete PD modalities, indicating insufficient budgets or overloaded programs. Modern PD modalities are an effective RRT alternative not yet fully exploited in the region, and we present recommendations to enhance it.