Seminars in nephrology最新文献

{"title":"Pediatric Kidney Care in Northern Central America: A Survey of Pediatric Nephrologists","authors":"Randall Lou-Meda MD ,&nbsp;Mynor Patzán MD ,&nbsp;Carlos Henríquez MD ,&nbsp;Aída Funes MD ,&nbsp;Carolina Rodríguez MD ,&nbsp;Mabel Sandoval MD ,&nbsp;Melvin Bonilla-Félix MD","doi":"10.1016/j.semnephrol.2025.151611","DOIUrl":"10.1016/j.semnephrol.2025.151611","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) is a public health problem worldwide. Guatemala, El Salvador, Honduras, and Nicaragua are among the top six countries of the continent with high mortality and years of life lost attributable to CKD. The magnitude of the gap in delivering pediatric kidney care in northern Central America has never been systematically documented, hindering the possibility of planning prevention and effective management. A survey was sent to the directors of pediatric kidney care referral centers in the aforementioned countries to understand the epidemiology and current state of the programs. The area has a total population of 40.4 million; 17 million (41%) are younger than 21 years. The median incidence of pediatric kidney failure (pKF) was 8.4 per million age-related population (pmarp), and the median prevalence was 34 pmarp. Peritoneal dialysis (PD) was the most prevalent kidney replacement therapy (KRT) in the form of continuous ambulatory peritoneal dialysis (CAPD). Hemodialysis (HD) was used in 26.5% of patients, and 30% had an arteriovenous fistula (AVF). Few children had access to transplantation (0.9 transplants pmarp). The rate of pediatric nephrologists pmarp ranged between 1.5 (Honduras) and 2.3 (Guatemala) pmarp. The public health system funds all four referral centers, but kidney foundations play an essential role. This article offers insight to support the development of a multinational plan for prevention, effective management, and strategic use of available resources for pediatric kidney care, including support from national and international initiatives.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151611"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular and Renal Risk Factors in the Argentine First Nations: A Study of the Qom and Wichi Indigenous Groups","authors":"María Eugenia Bianchi MD, PhD","doi":"10.1016/j.semnephrol.2025.151604","DOIUrl":"10.1016/j.semnephrol.2025.151604","url":null,"abstract":"<div><div>The “10 Recommendations for Global Kidney Health” developed at the Global Policy 2017 constitute a commitment by and challenge to all stakeholders. Achieving these goals in disadvantaged population such as the First Nation Peoples (FNP) is even more challenging. Qom and Wichi ethnics are isolated Argentine FNP with poor access to health care. Research on chronic kidney disease (CKD) in Qom FNP in the Chaco Province, Argentina showed high rates of proteinuria without a decrease of the glomerular filtration rate in a group of 385 persons in 2003. In 2018, a subsequent cross-sectional evaluation in those individuals still living in the area revealed that diabetes mellitus (DM) increased sixfold (from 2% to 14%) and obesity increased threefold (from 21% to 61%). Infections (tuberculosis) and cardiovascular disease were the main causes of mortality in the whole sample, whereas gynecologic cancer was the first cause of death in women and cardiovascular disease in men. In 2018, a new group of subjects (not those originally assessed in 2003) showed a remarkably high prevalence of renal risk factors despite being as young as those originally evaluated in 2003 but with a prevalence of renal risk factors as high as when the latter were assessed 15 years afterward. Wichi FNP, in 2020, showed lower proteinuria rates (14%) with virtually no presence of DM. FNP deserve the creation of public policies for CKD detection and treatment, but they must be based on local scientific evidence, with continuous monitoring and learning and scalable strategies.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151604"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury in Latin America","authors":"Rolando Claure-Del Granado MD, FASN, FISN ,&nbsp;Raúl Lombardi MD ,&nbsp;Jonathan Chávez-Íñiguez MD ,&nbsp;Lilia Rizo-Topete MD ,&nbsp;Daniela Ponce MD","doi":"10.1016/j.semnephrol.2025.151609","DOIUrl":"10.1016/j.semnephrol.2025.151609","url":null,"abstract":"<div><div>Acute kidney injury (AKI) is a major global health issue with significant morbidity and mortality, particularly in low- and middle-income regions like Latin America. AKI prevalence varies across Latin America, with higher rates in rural and underserved areas. Key risk factors include socioeconomic disparities, comorbid conditions such as diabetes and hypertension, and environmental hazards. Infections, especially tropical diseases, and exposure to nephrotoxins, including herbal remedies, are common causes of AKI. Management of AKI faces significant hurdles because of limited access to diagnostic tools, variability in clinical practices, and a shortage of trained health care professionals. The availability of dialysis and renal replacement therapies is often constrained by economic and infrastructural limitations. Public health initiatives focusing on prevention, screening, and early detection are critical to mitigate the impact of AKI. Research in AKI across Latin America is hampered by data gaps and limited funding. Multicenter collaborations and the development of region-specific guidelines are essential to improving outcomes. Addressing these challenges will help reduce the burden of AKI and improve health care systems across the region. This review examines the unique epidemiology, risk factors, and health care challenges surrounding AKI in the region.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151609"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Disease in Latin America: The Hottest Spot on the Globe","authors":"Alfonso M. Cueto-Manzano MD, MSc, PhD ,&nbsp;Valerie A. Luyckx MBBCh (Wits), MSc Public Health (LSHTM), PhD Biomedical Ethics and Law (UZH) ,&nbsp;Marina Wainstein MBBS, MA, PhD","doi":"10.1016/j.semnephrol.2025.151599","DOIUrl":"10.1016/j.semnephrol.2025.151599","url":null,"abstract":"","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151599"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Group Medical Care Models Transforming Access to Kidney Disease Treatment: An Argentine Experience","authors":"Marina Wainstein ,&nbsp;Paula Andrea Marioli ,&nbsp;Lilia Cervantes","doi":"10.1016/j.semnephrol.2025.151612","DOIUrl":"10.1016/j.semnephrol.2025.151612","url":null,"abstract":"<div><div>As the prevalence of kidney disease rises in Latin America, there is increasing awareness of the importance of early detection and prevention. However, in a region characterized by socioeconomic inequality, variable access to care, and an overwhelmed primary health system, health professionals must find new and innovative ways of delivering care that is cost effective and mindful of patients’ needs and social determinants of health. Group medical care (GMC), a model combining group visits and peer support with personalized care, has emerged as an intervention with proven benefits in clinical outcomes, patient satisfaction, and cost effectiveness in the management of chronic illnesses. In this article we present the case of <em>Renalida</em>, a kidney clinic in Argentina that has adopted GMC to improve access, engagement, and standards of care for older patients with chronic kidney disease (CKD). Beyond it being the first documented case of GMC for CKD in Latin America, <em>Renalida</em> brings to light many of the common barriers to effective early CKD care throughout the region and proposes a viable and holistic solution. In addition, we explore future directions, including the application of implementation science to leverage strategies such as GMC to improve both access to and quality of CKD care.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151612"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Health Programs in Latin America: Results of the SLANH Survey 2024","authors":"Alfonso M. Cueto-Manzano ,&nbsp;María C. Carlino-Bauza ,&nbsp;Pablo G. Ríos-Sarro ,&nbsp;Augusto C. Vallejos ,&nbsp;Carlos A. Zúñiga-San Martín ,&nbsp;Eric A. Zúñiga-Saravia ,&nbsp;Jessica Bravo-Zúñiga ,&nbsp;Alberto M. Alles-Gamberale ,&nbsp;Laura Solá-Schnir ,&nbsp;Vicente Sánchez-Polo ,&nbsp;Adriana Robayo ,&nbsp;Jorge Rico-Fontalvo ,&nbsp;Guillermo Álvarez-Estévez ,&nbsp;Comité de Salud Renal, Sociedad Latinoamericana de Nefrología e Hipertensión","doi":"10.1016/j.semnephrol.2025.151606","DOIUrl":"10.1016/j.semnephrol.2025.151606","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) is a health problem worldwide, but it is overexpressed in Latin America.</div><div>With the aim of understanding the status of kidney health programs (KHP) and provide information to help create or direct kidney health policies, the Kidney Health Committee of the Latin American Society of Nephrology and Hypertension (SLANH) developed an electronic survey that was sent (February 1–May 30, 2024) to the national nephrology society, the Ministry of Health or a policymaker, and a recognized local nephrology leader of all SLANH member countries. Thirteen of 20 (65%) member countries had a KHP. Although with variability, most covers individuals with and without social security, targeting people with risk factors with or without CKD (61%) or general population (39%). In all but two countries with KHP, it is integrated into another noncommunicable disease program (diabetes, hypertension, obesity, and/or cardiovascular disease), and the national nephrology society is involved (except in three). Virtually all countries perform educative interventions for multidisciplinary health professionals and general population, the latter mainly in connection with World Kidney Day. Only eight (40%) countries have a registry of CKD stage 1-4 (seven of them had a KHP), and nine (45%) have a kidney health law, which was not different between countries with or without KHP. Only 25% of countries have active patient participation in kidney issues, regardless of the country having KHP or not. The SLANH-KHP survey showed heterogeneity in the way Latin American countries address kidney health. These findings could guide the implementation of strategies aimed at reducing the burden of CKD toward equitable and sustainable kidney disease care.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151606"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Special Situations in Argentina: Addressing the Challenges Faced by Individuals on Dialysis Without a Diagnosis","authors":"Guillermo Rosa-Diez MD, MSc","doi":"10.1016/j.semnephrol.2025.151603","DOIUrl":"10.1016/j.semnephrol.2025.151603","url":null,"abstract":"<div><div>The third major subgroup requiring admission to dialysis in Argentina are individuals with kidney failure without a known cause, also known as chronic kidney disease of unknown origin (CKDUO). In this retrospective cohort study, the characteristics of this group were described using data from the National Dialysis and Transplant Registry. In Argentina, 113,352 patients commenced maintenance dialysis from April 1, 2004, to December 31, 2021 (213 months); 42% of patients were older than 65 years of age and 2.3% were younger than 18 years of age. There was a predominance of male patients (66,650 [58.8%]) and 6% were foreigners (6,688). Only 9.4% of patients (10,655) had a diagnosis confirmed by a kidney biopsy. The most common causes of kidney disease requiring dialysis admission were diabetic nephropathy (36%), hypertensive nephropathy (21%), and CKDUO (17%). The most frequent dialysis modality was hemodialysis and the majority were admitted with temporary vascular access. Mean survival time from the initiation of dialysis was 44.8 months, with 59.2 months (95% confidence interval, 58.0-60.4) for patients with CKDUO versus 48.6 months (95% confidence interval, 48.2-49.0) for others. Patients with CKDUO were younger and more frequently female, with fewer comorbidities, more precarious socioeconomic status, and indicators of late or absent renal health assistance. There was a heterogeneous renal biopsy rate by state related to the accessibility of diagnostic tools. Health policy and health actions are required to allow kidney health accessibility in earlier stages of chronic kidney disease.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151603"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Care During Pregnancy for Patients With Chronic Kidney Disease and Kidney Failure in Latin America: A State of the Art with an International Comparison","authors":"Alejandra Orozco MSc ,&nbsp;Rasha Shemies MD ,&nbsp;Luis Enrique Álvarez Rangel MD ,&nbsp;Hernan Trimarchi MD ,&nbsp;Guilherme Ribeiro Ramirez de Jesus MD ,&nbsp;Iasmina M. Craici MD ,&nbsp;Alice Schmidt MD ,&nbsp;Ghada Ankawi MD ,&nbsp;Nada Sellami MD ,&nbsp;I Wen Wu MD ,&nbsp;Wisit Cheungpasitporn MD ,&nbsp;Natalia Kozlovskaya MD ,&nbsp;Elena Zakharova MD, PhD ,&nbsp;Ifeoma I. Ulasi MD ,&nbsp;Shilpanjali Jesudason MD ,&nbsp;Giorgina Barbara Piccoli MD, PhD","doi":"10.1016/j.semnephrol.2025.151610","DOIUrl":"10.1016/j.semnephrol.2025.151610","url":null,"abstract":"<div><div>Access to kidney care is a problem in Latin America, similar to many other low- to medium-income countries. Uneven access and deep discrepancies in quality of care beset this large part of the world that encompasses North America (Mexico) and Central and South America.</div><div>Access to kidney care during pregnancy can be seen as a marker of overall achievements and needs in nephrology. We suggest that this issue should be systematically considered and compared across settings when health care systems are evaluated. If this were done, pregnancy would be in the spotlight, and this would increase awareness of the problems that need to be dealt with and could guide interventions to improve kidney care in young women.</div><div>This review discusses some epidemiological and clinical issues, as well as barriers to optimal care of pregnancy in patients with chronic kidney disease encountered in Mexico and other Latin American countries, contextualized with a brief overview on barriers and challenges in other continents.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151610"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessibility to Kidney Replacement Therapy in Latin America","authors":"Alejandro Ferreiro-Fuentes","doi":"10.1016/j.semnephrol.2025.151605","DOIUrl":"10.1016/j.semnephrol.2025.151605","url":null,"abstract":"<div><div>Latin America is made up of 21 countries with a population of around 660 million, of whom 550,000 receive kidney replacement therapy (KRT). The enormous burden of disease that KRT imposes can be attributed to multiple determinants of the disease, linked to the characteristics of the population: co-morbidity, social factors, limited access to the health care system, poverty, extreme working conditions, and low levels of education. In many countries, the health care system is fragmented, making it difficult to ensure the continuity of the health care process and to adress inequities in access to KRT. Differences among countries in the prevalence of KRT translate into thousands of lives lost each year. Differences in access to KRT are linked to structural and investment differences in health care systems, so financing and organization characteristicsmight have a major bearing on equitable access to KRT. One of the main objectives of the nephrology community should be to develop activities to reduce gaps in the burden of KRT. There is no doubt that alliances with health care policy makers, ministries of health, regional patient organizations, regional nursing organizations, health regulatory agencies, and international nephrology societies will achieve results by working together, in synergy.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151605"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Improving Promotion of Kidney Health and Access to Kidney Care: Perspectives From Leaders of Patient Organizations in Honduras","authors":"Marianella Canales Mejia ,&nbsp;Daniela Alejandra Ordóñez Quezada ,&nbsp;Cristina Valeria Sequeira Navarro ,&nbsp;Jossel Ivan Meza Rodriguez ,&nbsp;Andrea Nicole Izaguirre Baday","doi":"10.1016/j.semnephrol.2025.151600","DOIUrl":"10.1016/j.semnephrol.2025.151600","url":null,"abstract":"<div><div>Accessibility to kidney care is an essential component to ensure that patients with chronic kidney disease receive the necessary treatment in a timely and equitable manner. From our perspective as patients and/or leaders of patient organizations, we have observed how geographic, economic, informational, and psychosocial barriers negatively affect timely access to kidney health services, especially in Latin America. Improving access to kidney care is a complex challenge that requires a comprehensive approach, with an inclusive and equitable assertiveness. This includes not only the elimination of inequalities in access to treatments such as dialysis or kidney transplant, which is a reality that affects many patients, especially those in remote rural or low-income areas, but also access to prevention, early detection, and early treatment to prevent kidney failure. Improvements in education and information can make significant gains that benefit all people at risk of, or who suffer from, kidney disease at all stages of advancement, regardless of their location or socioeconomic status. Therefore, policies are needed that focus not only on access to technology and its proper use but also on bringing these solutions to everyone, without forgetting the importance of emotional and psychosocial support, thus humanizing health care. This is a call to action for all actors involved, from health authorities to service providers, medical and scientific societies, and patient organizations, to work together to build a more accessible and equitable kidney health system for all kidney patients.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"45 1","pages":"Article 151600"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}