Are segments of the developing world competing in end-stage renal disease (ESRD)?

Abstract

Sir, Trinidad and Tobago are the southernmost islands in the Caribbean archipelago with a population of 1.3 million, consisting of two major diaspora Africans and Southeast Asians. An economy buoyant by petroleum exports is responsible for a GDP per capita of 10 894.4 ($US). The number of patients (n = 436) with ESRD receiving dialysis is the highest in comparison with Jamaica (n = 366), Bahamas (n = 211), Barbados (n = 185), Cayman Islands (n = 41) and the British Virgin Islands (n = 27) [1]. In Jamaica and Trinidad, the two most common causes of ESRD are diabetes and hypertension. The management of ESRD in Trinidad is mainly by dialysis provided by the state at two major tertiary centres on the island. To receive dialysis, patients must only be hepatitis B surface antigen negative; patients infected with the human immunodeficiency virus (HIV) or those who are hepatitis C virus (HCV) seropositive are not excluded. A study of the trends in the prevalence and epidemiology of ESRD during the period 1999–2007 at one of these haemodialysis sites was conducted using a retrospective cohort design. Between 1999 and 2004 the number of new cases seeking dialysis was 5 per annum; however, in 2005, 2006 and 2007, there were 14, 16 and 26 new cases, respectively. During this period there were no unusual patterns of disease occurrences or any special interventions, either clinical or promotional, to detect renal disease. The mean age among men was 52 (SD ± 13.9) years as compared to women 46.8 (SD ± 14.9) years; a similar finding was reported by Soyibo and Barton [1]. In contrast, Reikes showed in 2000 that, in the United States, the highest incidence rate of ESRD occurs in patients 64 years and older [2]. This implies that in the Caribbean population ESRD occurs at an earlier age. There were more Africans (45.7%) than Southeast Asians (39.5%), and hypertension (70.4%) and diabetes (40.7%) were the commonest comorbid conditions, similar to findings reported by Brown [3] and Lane et al. [4]. In conclusion, we provide epidemiological evidence of ESRD of epidemic proportions in Trinidad. Conflict of interest statement. None declared.