Peritoneal Dialysis in Argentina. A Nationwide Study

Abstract

Correspondence to: J. Lobo, Correa 2864, Buenos Aires, 1429 Argentina. jlobo@intramed.net.ar Received 11 September 2009; accepted 22 June 2010. Although most patients on dialysis are in the USA, Europe, and Japan, the highest rate of growth is expected to take place in the countries of Asia, Middle East, Latin America, and Africa (1). In Latin America, between the years 1992 and 2004 the prevalence of patients on renal replacement therapy (RRT) rose from 129 to 447 patients per million population (pmp) (2). Peritoneal dialysis (PD), like RRT in general, has spread widely around the world and its prevalence varies according to the different regions and countries (3–5). Some of the recent publications reporting its use in Latin American countries are listed in Table 1 (6–13). Argentina is a country in southern South America with a territory of 2791810 km2 (Figure 1). In 2007, its estimated population was 39356000 and its average population density was 14.1 inhabitants/km2 (14). That year, the Gross Domestic Product per capita was US$6050, life expectancy was 75 years, and 98.5% of children were enrolled in primary school (15). The National Health System (NHS) is covered by the Public Health System, the Social Securities, and the Private Health System. Through the Mandatory Medical Program, the NHS provides patients with a variety of essential services, such as hemodialysis (HD) and PD (16). In Argentina, the use of intermittent PD started in the 1960s. Toward the end of 1978, the first catheter for continuous ambulatory PD (CAPD) was implanted in a patient in Buenos Aires, with material produced locally. In 1980, Travenol materials became available, which reduced the rate of peritonitis from 1 episode every 4 months to 1 episode per year. In the late 1990s, PD became more widely known and had its main development (17). In spite of the rapid introduction of the double-bag system and the increased availability of cycling machines for automated PD (APD), the proportion of patients on PD compared to HD was still low, with a prevalence of only 5.5% at the end of the decade (18). Afterward, with the economic crisis in 2001, the cost of PD rose steeply and many patients had to be transferred to HD. At present, as will be discussed later, the use of PD is low. PD IN THE DEVELOPING WORLD