Capacity for the management of kidney failure in the International Society of Nephrology Latin America region:Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Successful management of chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to high disease burden and geographic disparities and difficulties in terms of capacity, accessibility, equity, and quality of kidney failure care. Although LA has experienced significant social and economic progress over the past decades, there are still important inequities in healthcare access. Through this third iteration of the International Society of Nephrology Global Kidney Health Atlas, the indicators regarding kidney failure care in LA are updated. Survey responses were received from 22 (71%) of 31 countries in LA representing 96.5% of its total population. Median CKD prevalence was 10.2% (IQR 8.4 - 12.3), median CKD disability-adjusted life year (DALYs) were 753.4 days (IQR 581.3 -1,072.5), and median CKD mortality was 5.5% (IQR 3.2 - 6.3). Regarding dialysis modality, hemodialysis (HD) continued to be the most utilized therapy, while peritoneal dialysis (PD) reached a plateau and kidney transplantation increased steadily over the past 10 years. In 20 (91%) countries, >50% of people with kidney failure could access dialysis; and in only 2 (9%) countries, people who had access to dialysis could initiate dialysis with PD. A mix of public and private systems collectively funded most aspects of kidney replacement therapy (KRT; dialysis and transplantation) with many people incurring up to 50% of out-of-pocket costs. Few LA countries had CKD/KRT registries and almost no acute kidney injury (AKI) registries were reported. There was large variability in the nature and extent of kidney failure care in LA mainly related to countries’ funding structures and limited surveillance and management initiatives