Chronic Kidney Disease Takes Growing Toll in Latin America

Over the past 30 years, chronic kidney disease has become one of the leading causes of death and years of healthy life lost in Latin America.

The increase in the disease burden results more from premature deaths than from the disability associated with the pathology. No country in the region has managed to avoid the troubling impact, but some, such as Nicaragua, El Salvador, Guatemala, and Mexico, stand out for having the highest standardized rates of years lost due to premature deaths, disability-adjusted life years for chronic kidney disease.

The data come from a study published in the Pan American Journal of Public Health by authors from the National Autonomous University of Mexico in Mexico City. They arose from a secondary and ecological analysis of data from the Global Burden of Disease, Injuries, and Risk Factors Study 2019.

The numbers are concerning, study author Marcela Agudelo Botero, PhD, a doctor of population studies and member of the Research Center in Policies, Population, and Health at the National Autonomous University of Mexico’s Faculty of Medicine, told the Medscape Spanish edition. Without taking action to prevent risk factors in the entire population and without guaranteeing effective access, continuity, and quality care for people living with chronic kidney disease, this trend will continue to rise. It is important to note that diabetes and systemic arterial hypertension were the main underlying causes in almost all countries analyzed.

The research reflected how chronic kidney disease has silently gained ground in Latin American countries, in terms of mortality and years of healthy life lost. During the period 1990-2019, chronic kidney disease rose from the 13^th leading cause of death to the second leading cause of death. The increase was only slightly less precipitous in Chile, El Salvador, and Venezuela.

Regarding years of healthy life lost, the standardized rates are also not reassuring. From 1990 to 2019, chronic kidney disease became a significantly more important cause of years of healthy life lost across the region, except in Argentina and Colombia.

Taking both indicators into account, El Salvador, Guatemala, Nicaragua, and Mexico appear among the countries most affected. In contrast, in Brazil, Chile, Colombia, and Uruguay, the impact seems to have been smaller.

The gap in these indicators could result from various factors, such as demographic changes; urbanization; increasing exposure to environmental, commercial, nutritional, and social risk factors; or various economic and cultural realities in the countries of the region, according to the investigators.

Chronic kidney disease manifests itself when it is inevitable that people will require renal replacement therapies. And it is invisible because despite the figures exposed in this article, very few countries have renal health policies, sufficient resources, and sustainable programs over time. This has led to the disease being relegated to a secondary priority, said Agudelo.

Huge Public Health Challenge

Chronic kidney disease represents a progressive epidemic and a significant public health problem. Globally, the standardized mortality rate increased by 2.8% during the 1990-2017 period. In 2017, the rate was 15.9% per 100,000 people. If this trend continues, chronic kidney disease is projected to become the fifth leading cause of mortality on the planet by 2040.

Moreover, the impact will remain unequal and more pronounced in middle- and low-income countries, as in most of Latin America, where this disease already represented the fourth leading cause of mortality in 2019. Several countries in the region have some of the highest mortality rates from chronic kidney disease in the world.

The data presented show the enormous challenge in the region that needs to be urgently addressed by policymakers and decision-makers. First, it is necessary to generate and maintain robust and reliable records on different aspects of chronic kidney disease, which includes having data on people at risk for the disease. Second, there is a need for countries to develop and implement explicit public policies to prevent the disease and ensure treatment and care for those who need it, regardless of their health insurance status, said Agudelo.

Enacting public policies would allow efforts and resources to be focused on the most vulnerable populations, she added. Countries need to generate and implement public policies to prevent the disease and to guarantee treatment and care for those who require it, regardless of their health insurance status.

Chronic kidney disease is considered catastrophic when renal replacement therapies are required. Ensuring financing for these therapies has become a major challenge for the governments and healthcare systems of Latin America.

The authors noted that the lack of care has previously been associated with higher mortality and other unfavorable outcomes in patients with chronic kidney disease. They pointed out that few countries in the region have designed and implemented public policies to prevent, contain, and reduce the burden of renal disease.

In Colombia and Uruguay, programs have been established and resources allocated for renal healthcare. However, in countries like Mexico, El Salvador, and Nicaragua, individuals with chronic kidney disease have little or no access to renal replacement therapies.

The worrying outlook is completed by statistics showing low access to kidney transplants for patients throughout Latin America. Statistics in the region indicate a median of 68.8 transplants per million people. This figure is significantly below that seen, eg, in Western Europe (535.5 transplants per million people).

Preventive, Multidisciplinary Approach

Another challenge for Latin American patients with chronic kidney disease is their limited access to nephrology specialists. There are around eight professionals per million people, which is well below the 20 per million people considered necessary.

Having only nephrology specialists may not be enough to reduce the burden caused by chronic kidney disease, however. This pathology, of which arterial hypertension, diabetes, and obesity are the main risk factors, requires a multidisciplinary approach.

The number of patients with diabetes in Latin America was estimated to be 43 million in 2021. By 2050, the number is projected to rise to 121 million. In addition, the region had one of the highest increases in obesity prevalence between 1985 and 2016.

A multidisciplinary approach is crucial. Initially, this includes clinical doctors, promoting control of risk factors, and improving health access by the population. Then the interaction of specialists can reduce the comorbidities that exist around or at the onset of chronic kidney disease, said Javier Farias, MD, endocrinologist and director of the specialty physicians in endocrinology program at the University of Buenos Aires in Buenos Aires, Argentina.

It is essential in Latin America to control rates of overweight and obesity, especially in children and pregnant women, said Farias. Dietary changes are key, and they can be encouraged not only through food labeling but also through education in schools, promoting healthy foods free from endocrine disruptors, and implementing measures to prevent food insecurity, he added. 

Additionally, promoting physical activity and mobility, improving sleep health, and working toward green cities are necessary. The latter is particularly challenging in our regions because we are in contexts of violence or insecurity, said Farias.

The low mortality rates in Uruguay and Colombia are positive findings. I feel that a health system based on prevention and health promotion can have an impact on these indicators, said Farias.

For her part, Agudelo indicated that the key message of this research for doctors is that, now more than ever, health literacy in renal health is essential. Communication between healthcare professionals and the community must be ongoing and fluid.

She also stressed the need to position chronic kidney disease on governments public agenda and emphasize the importance of renal health for everyone. This [step] should be accompanied by actions to increase early detection of the disease, as well as sensitize and train healthcare personnel, who must have standardized clinical guidelines and protocols. The overarching policy for renal health should be supported by financial, human, and material resources, said Agudelo.

Agudelo and Farias declared no relevant financial conflicts of interest.

This story was translated from the Medscape Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.