Global Dialysis Perspective: Guatemala.

Abstract

Guatemala is an upper-middle-income country of 16.4 million people located in Central America (1). The gross domestic product in Guatemala is 76 billion USD. In 2014, health financing (public and private) represented 6% of gross domestic product, and the proportion of government expenditure on health was only around 35% of the total health expenditure. In 2019, approximately 19 million USD per year was destined for kidney care in the public health sector. The Guatemalan Ministry of Health (MoH) is financed through general government revenues (taxes) (2). Around 50% of the Guatemalan population are indigenous Maya people who live in rural communities, where access to healthcare, including kidney care and dialysis, is limited (3,4). The Pan American Health Organization estimated that mortality due to chronic kidney failure in Guatemala in 2008 was 13.6 per 100,000 people, one of the highest rates in the Americas (5). In 1964, the first Guatemalan nephrologist, Dr. Cesar Augusto Vargas Monterroso, returned after completing his training at Walter Reed National Military Medical Center in the United States. It was not until 1975 that the first hemodialysis (HD) service was created in the Instituto Guatemalteco de Seguridad Social (IGSS; Guatemalan Institute of Social Security). However, the true rise and development of the HD technique were promoted when IGSS introduced freestanding dialysis centers in 1996. This program was first launched and led by Dr. Jose Vicente Sanchez Polo (6). IGSS serves the Guatemalan patients who have social security, which represents approximately 40% of all individuals with the diagnosis of with CKD or ESKD (7). In 1997, the Guatemalan MoH created the Unidad Nacional de Atencion al Enfermo Renal Cronico (UNAERC; National Center for Chronic Renal Disease), which is the only freestanding dialysis provider for those who are uninsured and without social security (2). As …