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Chronic Kidney Disease (CKD) is increasing worldwide due to the aging population and rising prevalence of diabetes and hypertension. According to Global Kidney Health Atlas, Latin America (LA) has a 10,15% CKD prevalence and 5,51% CKD mortality, contributing exponentially to global statistics. Regarding treatment, although dialysis is the most commonly used treatment for kidney failure, it has been shown that kidney transplantation (KT) offers a superior quality of life and is economically advantageous and it is prioritized by Internacional Society of Nephrology (ISN) above all other methods of kidney replacement therapy (KRT). That considered, it is important to analyze the KT scenario in Latin America.
Retrospective analysis study of KT absolute number and number per million population (PMP) in LA and Brazil in the period of 2018-2022. The criteria applied to choose the LA countries was the prevalence of CKD according to Global Kidney Health Atlas released in July 2023 by ISN. The countries selected were: Costa Rica, Mexico, Cuba, Panama, Colombia, Nicaragua and Chile. The data of kidney transplants profile in Brazil was collected in Brazilian Organ Transplant Association (ABTO) registrations and the others Latin America's countries was based on the information presented by Global Observatory on Donation and Transplantation (GODT) and Latin-American Society of Nephrology and Hypertension (SLANH).
The countries that stood out in KT each year, based on number PMP, were Brazil (5.952 KT, 28.7 PMP), Mexico (3.081 KT, 23.6 PMP) and Costa Rica (63 KT, 18.0 PMP) in 2018; Brazil (6.302 KT, 30.2 PMP), Mexico (2.976 KT, 22.5 PMP) and Chile (410 KT, 22.4 PMP) in 2019; Brazil (4.826 KT, 23.0 PMP), Chile (233 KT, 12.2 PMP) and Colombia (526 KT, 10.0 PMP) in 2020; Brazil (4. 777 KT, 22.6 PMP), Colombia (623 KT, 17.0 PMP) and Mexico (1.974 KT, 15.15 PMP) in 2021 and Brazil (5.306 KT, 24.9 PMP), Mexico (2.713 KT, 20.6 PMP) and Chile (326 KT, 16.9 PMP) in 2022. In Brazil, in this period, there were around 58.230 potential donors, of which 17.367 were effective donors. In 2022, the estimated kidney transplant needed was 12.609 and the number of transplants was 5.306, almost three times lower. The analysis demonstrates that most of these LA countries, although presented with high rates of CKD, have limited access to KT as an available treatment. In comparison, the absolute number and number PMP of KT in Brazil stood out every year, which reveals a significant investment in this treatment category, although it presented a significant rate reduction around 23,8% from 2019 to 2020. In addition, the number of effective donors, compared to the real necessity, points out a demand that still needs to be attended to in Brazil. The difference, almost four times lower, between the potential number of donors and the number of actual donors proves to be one of the causes.
It was evident a progression and stabilization of KT until 2019, followed by a tendency of reduction, starting in 2020, mainly related to the pandemic and its long-term social and economic consequences. In conclusion, the search for other factors that explains the delay in KT progression it's essential to define action planning by the Brazilian and other Latin American government, improving access to KT to fill the demand of terminal CKD patients.