Pediatric Kidney Care in Northern Central America: A Survey of Pediatric Nephrologists

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.