PP.07.18] CHRONIC KIDNEY DISEASE, END STAGE RENAL DISEASE, AND KIDNEY TRANSPLANTATION IN SURINAME

Abstract

Objective: The high hypertension and diabetes burden in low and middle income countries is expected to lead to an increase in chronic kidney disease (CKD) and the need of renal replacement therapy. We aimed to estimate the prevalence of CKD and end stage renal disease (ESRD), and assess the availability of kidney transplantation in Suriname, a middle income country with a current population size of nearly 574.000 persons of mainly South Asian and African descent. Our previous studies showed that around 80% of the adult population is prehypertensive or hypertensive, and around 26% has prediabetes or diabetes. Design and method: We analysed data of the Healthy Life in Suriname (HELISUR) study, a random population sample, to estimate the number of patients with CKD (eGFR <60 ml/min/1.73 m2) and ESRD (eGFR <15 ml/min/1.73 m2); and analysed data of dialysis centers to assess the number of patients on renal replacement therapy. Results: We found that around 2% of the adult population had CKD (est. n = 11.500). Of these, 63% had an eGFR of 30–59; 28% of 15–29, and 9% of <15 mL/min/1.73 m2 (est. n = 1035). The number of patients on hemodialysis has starkly increased in the past years. In 2014, 516 patients were on maintenance dialysis. The majority of these patients (76%) had a history of hypertension, 47% had a history of diabetes, and 30% had both conditions. There was no health care facility to provide renal transplants or predialysis care. Although all patients had health insurance, patients experienced difficulties in accessing dialysis. In particular transportation to the clinic and out-of-pocket expenses for drugs were unaffordable for low-income patients. Conclusions: The high cardiovascular risk burden in Suriname creates a challenge for the health-care system to provide and sustain renal replacement therapy. Kidney transplantation is not available in Suriname. A previous study showed this to be mainly due to the lack of technical means to perform the procedure and the lack of eligible donors. Thus, our results highlight the need for effective population-based strategies to reduce the cardiovascular disease burden of hypertension and diabetes, and prevent kidney failure.