Status of Peritoneal Dialysis in Latin America

Latin America is a heterogeneous region comprised of 20 countries, former colonies of European countries, in which Latin-derived languages are spoken. According to the Latin American Society of Nephrology and Hypertension/ Sociedad Latino Americana de Nefrologia e Hipertensión (SLANH), the acceptance rate for renal replacement therapy is 103 new patients per million population. In Latin America, hemodialysis is the predominant form of replacement therapy for end-stage renal disease; however, some countries employ peritoneal dialysis (PD) in 30% or more patients. In particular, Mexico is the country with the largest PD utilization in the world, and furthermore, it is estimated that approximately 25% of the world's PD population may be found Latin America. Data concerning clinical practice and long-term outcome of PD in Latin America are scarce, although regional registries are increasing in number and quality. In this review article, we present an overview of the situation of PD in several countries of Latin America, based on the registry of the SLAHN, national registries, and personal communication with PD experts from different countries.

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Peritonitis in Latin America

Peritoneal Dialysis International ◽

10.1177/089686080702700324 ◽

2007 ◽

Vol 27 (3) ◽

pp. 332-339 ◽

Cited By ~ 14

Author(s):

Pasqual Barretti ◽

Kleyton A. Bastos ◽

Jorge Dominguez ◽

Jacqueline C.T. Caramori

Keyword(s):

Latin America ◽

Peritoneal Dialysis ◽

Latin American ◽

Developed Countries ◽

Climatic Conditions ◽

Coagulase Negative Staphylococcus ◽

Great Relevance ◽

Resistant Strains ◽

Technological Improvements ◽

High Acceptance Rate

Peritoneal dialysis has a high acceptance rate in Latin America, thus the knowledge concerning complication patterns is of great relevance. This work reviews Latin American data on peritonitis, the most serious complication of peritoneal dialysis. The incidence of peritonitis has been reduced over time, concomitantly with the incorporation of safer exchange systems and the use of prophylactic measurements. Today, rates lower than 1 episode per 24 patient-months are commonly reported. Furthermore, changes in causative organisms have been observed, with predominance of Staphylococcus aureus up through the mid-1990s, as well as increases in coagulase-negative staphylococcus and participation of gram negatives. However, the prevalence of S. aureus is still high, due possibly to climatic conditions and the elevated prevalence of carriers. Resolution rate varies from 55% to 78%, transfer to hemodialysis from 10.9% to 15.4%, and death in 3% to 9.9% of cases. Outcome is worse in S. aureus episodes compared to those with coagulase-negative staphylococcus, despite the higher percentage of oxacillin-resistant strains among the former. In general, despite socioeconomic or climatic conditions, our results are similar to those in developed countries, perhaps as a consequence of technological improvements and/or center expertise.

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Policies and Health Care Financing Issues for Dialysis in Latin America: Extracts from the Roundtable Discussion on the Economics of Dialysis and Chronic Kidney Disease

Peritoneal Dialysis International ◽

10.1177/089686080902902s45 ◽

2009 ◽

Vol 29 (2_suppl) ◽

pp. 222-226 ◽

Cited By ~ 9

Author(s):

Roberto Pecoits–Filho ◽

Camilo Campos ◽

Manuel Cerdas–Calderon ◽

Paulo Fortes ◽

Cecilia Jarpa ◽

...

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Latin America ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Health Care Financing ◽

Medical Intervention ◽

Roundtable Discussion ◽

Early Medical Intervention ◽

The Future

During the 2008 Congress of the International Society for Peritoneal Dialysis, academic nephrologists, nephrology societies, and government officials from Colombia, Brazil, Argentina, Chile, Central America, Ecuador, and Mexico participated in a roundtable discussion on the Economics of Dialysis and Chronic Kidney Disease in Latin America. The main focus was policy and health care financing. The roundtable promoted open discussion between policymakers and clinicians on how to find viable solutions to contain spending on treatment for end-stage renal disease into the future. A number of options were proposed, including early medical intervention (disease management programs) to slow the progression of chronic kidney disease in high-risk patients, promotion of pre-emptive renal transplantation, and use of the most cost-effective dialysis therapy that can be offered to a patient without compromising outcome. It was concluded that the burden of treating more patients in the future could be alleviated by wider utilization of peritoneal dialysis (PD). However, important changes in health care reimbursement systems and realignment of incentives in the region are required to support wider PD penetration.

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History of Peritoneal Dialysis in Latin America

Peritoneal Dialysis International ◽

10.1177/089686080702700322 ◽

2007 ◽

Vol 27 (3) ◽

pp. 322-327 ◽

Cited By ~ 12

Author(s):

Miguel C. Riella ◽

Alberto J. Locatelli

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Latin America ◽

Peritoneal Dialysis ◽

Rural Areas ◽

End Stage Renal Failure ◽

Health Authorities ◽

Or Groups ◽

The 1960S ◽

End Stage

Latin America is a region formed by a number of countries of Latin heritage in which the common languages spoken are Spanish and Portuguese. Latin America was not isolated from the evolution of peritoneal dialysis (PD) throughout the rest of the world, as evidenced by the fact that, between the 1940s and the 1960s, PD was used to treat acute renal failure patients and later for the intermittent treatment of end-stage renal failure patients. The true development of PD took place toward the end of the 1970s and beginning of the 1980s with the introduction of continuous ambulatory peritoneal dialysis (CAPD). It is evident that the introduction of CAPD in most countries was a result of the personal effort and interest of individuals or groups of nephrologists. Initially, PD was not always implemented under ideal circumstances; locally manufactured, improvised supplies were associated with poor results. The arrival of companies with appropriate equipment and supplies led to widespread dissemination of this new modality. Furthermore, regulations and reimbursement by health authorities were additional obstacles. It is clear that PD in Latin America is still largely utilized to treat acute renal failure patients, particularly in countries where hemodialysis is not readily available. It is still employed intermittently to manage end-stage renal failure patients when hemodialysis is not available. With the exception of Colombia and Mexico, CAPD penetration is below 10%. While CAPD is nonexistent in certain countries, such as Cuba, due to lack of supplies, in other countries, such as Chile, it is restricted to patients that cannot be placed or continued on hemodialysis, those for example who lack vascular access, or those from remote rural areas. In addition, automated PD is relatively more costly and is therefore restricted in some countries.

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Inflammation in Peritoneal Dialysis: A Latin-American Perspective

Peritoneal Dialysis International ◽

10.1177/089686080702700326 ◽

2007 ◽

Vol 27 (3) ◽

pp. 347-352 ◽

Cited By ~ 9

Author(s):

Alfonso M. Cueto-Manzano ◽

Liliana González-Espinoza ◽

Fabiola Martin del Campo ◽

Paulo C. Fortes ◽

Roberto Pecoits-Filho

Keyword(s):

Risk Factors ◽

Latin America ◽

Peritoneal Dialysis ◽

Latin American ◽

High Mortality ◽

Mortality Risk ◽

Adult Population ◽

High Energy ◽

Increased Risk ◽

Sanitary Conditions

Peritoneal dialysis (PD) patients present an extremely high mortality rate, but the mechanisms mediating the increased risk of mortality observed in this group of patients are still largely unknown, which limits the perspective of effective therapeutic strategies. The leading hypothesis that tries to explain this high mortality risk is that PD patients are exposed to a number of traditional risk factors for cardiovascular disease (CVD) already at the onset of their chronic kidney disease (CKD), since many of these risk factors are common to both CVD and CKD. Of particular importance, chronic inflammation recently emerged as an important novel risk factor related to multiple complications of CKD. There are many stimuli of the inflammatory response in CKD patients, such as fluid overload, decreased cytokine clearance, presence of uremia-modified proteins, presence of chronic infections, metabolic disturbances (including hyperglycemia), obesity. Many of these factors are related to PD. Latin America has made some progress in economic issues; however, a large portion of the population is still living in poverty, in poor sanitary conditions, and with many health-related issues, such as an increasing elderly population, low birth weights, and increasingly high energy intake in the adult population, which, in combination with changes in lifestyle, has provoked an increase in the prevalence of obesity, diabetes, and CVD. Therefore, in Latin America, there seems to be a peculiar situation combining high prevalence of low education level, poor sanitary conditions, and poverty with increases in obesity, diabetes, and sedentary lifestyle. Since inflammation and mortality risk are intimately related to both sides of those health issues, in this review we aim to analyze the peculiarities of inflammation and mortality risk in the Latin-American PD population.

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The Genesis and Internal Dynamics of El Salvador's People's Revolutionary Army, 1970–1976

Behavioral and Brain Sciences ◽

10.1017/s0140525x13009850 ◽

2014 ◽

Vol 38 (01) ◽

pp. 102-129

Author(s):

ALBERTO MARTÍN ÁLVAREZ ◽

EUDALD CORTINA ORERO

Keyword(s):

Latin America ◽

El Salvador ◽

Early Years ◽

Left Wing ◽

Internal Dynamics ◽

Internal Coherence ◽

The 1960S

AbstractUsing interviews with former militants and previously unpublished documents, this article traces the genesis and internal dynamics of the Ejército Revolucionario del Pueblo (People's Revolutionary Army, ERP) in El Salvador during the early years of its existence (1970–6). This period was marked by the inability of the ERP to maintain internal coherence or any consensus on revolutionary strategy, which led to a series of splits and internal fights over control of the organisation. The evidence marshalled in this case study sheds new light on the origins of the armed Salvadorean Left and thus contributes to a wider understanding of the processes of formation and internal dynamics of armed left-wing groups that emerged from the 1960s onwards in Latin America.

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Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100119429 ◽

1985 ◽

Vol 43 ◽

pp. 520-521

Author(s):

William J. Lamoreaux ◽

David L. Smalley ◽

Larry M. Baddour ◽

Alfred P. Kraus

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Staphylococcus Epidermidis ◽

Sterile Saline ◽

Intravascular Devices ◽

Capd Patient ◽

Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

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