2. Population: 519,200,000 GNI: 3550 dollars per capita Life expectancy: 70.5 years Human development index; 0.777 Increase population; 1.5% annually Population > 65 years old: 5.6% END STAGE RENAL DISEASE AND PREVENTION STRATEGIES IN LATIN AMERICA Latin America

4. Life and healthy expectancy at birth in countries of South and Central America and Caribbean 40 50 60 70 80 Industrialized countries(Mean  95%CI) Life expectancy at birth Healthy Life expectancy Years

10. SLANH: 20 countries, population 509,565,697 Report 2000-2001: Dialysis: 14/20 countries ( 90% of LA population ) Kidney Transplants from 18/20 countries, ( 96 % of LA population) LA Registry of Dialysis and Transplantation Reports: 1991-2001

11. Transplants (x 1000) 55% Living donor (except Argentina, Chile, Colombia, Cuba, Puerto Rico, Uruguay and Venezuela)

12. Latin American Registrty: Treatment of ESRD, all modalities, 1992-2001 (Courtesy Dr. Cusumano 2003)

14. Population: 461913654 Dialysis Prevalence in Latin America 277.1 pmp HD 197 DP 80.1 Number of patients (14 countries, 90% LA pop.): HDC 92767; DP 37727 (México 86%), Living with functioning kidney Tx: 34044 LATIN AMERICAN REGISTRY Prevalence by dialysis modality, pmp, 31/12/01

15. Dialysis incidence in LA 91.4 pmp Theoretical Incidence: 130 ppm Unmet demand 40 ppm Not getting dialysis: 18842 pts Only 1/14 countries over the theoretical incidence

16. Diabetic nephropathy: SLANH 2001: 33%USRDS 2000: 45% Australia 2001: 25%New Zealand: 37% EDTA-ERA 2000: 22.4% Japan 2000: 36.6% Etiology ESRD Diabetic nephropathy 33% Hypertension 32% Chronic GN 9% Not defined 11% Others 15%

17. Latin American Registry: Progressive increase of diabetic patients (1991-2001) n= 18486 %

18. Some risk factors of ESRD in Latin America Diabetes Hypertension Low birth weight

19. The cost of diabetes in Latin America and the Caribbean. Bull World Health Org 81:20-23, 2003 Direct Health costs of Diabetes in LA 02505007501000 Argentina Uruguay Chile Panama Venezuela Costa Rica Brazil Mexico Colombia Paraguay Trinidad El Salvador Jamaica Cuba Peru Domin Rep Guatemala Ecuador Honduras Bolivia Nicaragua Haiti Per capita annual health expenditure Per capita annual direct costs of diabetes US Dollars Excess cost of diabetes 114 - 2517%

20. Prevalence (%) Known (%) Treated (%) Controlled (%) Argentina28.1544214.3 Brazil26.8503010 Chile22.84326.18.2 Ecuador28.741236.7 Mexico30.5283822 Paraguay30.533.518.37.8 Peru22402010 Uruguay33684211 Venezuela32.447378.5 Cuba prevalence ~ 30% (50% >60 años) known in 75% (**) Hypertension In Latin America (*) (*) Consenso Latinoamericano sobre hipetensión arterial. J Hypertens (Edición en Español) 6:1-27, 2001 (**) De la Osa JA. Hipertension arterial. // consulta.cuba.cu; Salazar J, Aguilar J. Prevalencia de la hipetensión arterial en un consultorio médico de familia. www.informed.sld.cu/revistas/san (°) Velazquez-Monroy et al. Arch Cardiol de México. 73:62-77, 2003

21. Low birth weight in LA 0.02.55.07.510.012.515.0 Chile Paraguay Costa Rica Argentina Mexico Uruguay Cuba Honduras Panamá Venezuela Colombia Jamaica Trinidad Brasil El Salvador Peru Rep Dominicana Bolivia Ecuador Guatemala Haiti NIcaragua mean LA mean industrialized countries % live births with <2500g //utal.org/segsocial/index.htm 1998

22. Prevention Strategies: To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention Reduce cost of medications with the potential to retard progression of ESRD Free access to full text publications to strengthen academic nephrology. Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) Support and advise in the design of epidemiologic studies

23. COMGAN has supported events in all LA countries Invited speakers Simposia Side visits Fact finding trips To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention

24. “Only 48% of the studies published between 1966 and 2000 to estimate the prevalence of hypertension in Latin America meet a critical thereshold to be useful for surveillance purposes” Ordúñez P, Silva LC, Paz M, Robles S. Prevalence estimates for hypertension in Latin America and the Caribbean: Are they useful for surveillance? Pan Am J Public Health 10:226-230, 2001 Support and advise in the design of epidemiologic studies

25. Conjunto de Acciones para la Reducción Multifactorial de las Enfermedades No transmisibles PAHO Rafael Burgos & Santos Delpine Sustenable and tenable renal health model. A Latin American proposal Support efforts to engage the government in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)

26. Prevention Strategies: To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention Reduce cost of medications with the potential to retard progression of ESRD Free access to full text publications to strengthen academic nephrology. Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) Support and advise in the design of epidemiologic studies

27. 182.67 millions 33.35 millions 6.31 millions 190.91 millions 5.12 millions 187.24 millions World Total of Internet Users 605.6 million Source: Jupitermedia CorporationNua Internet surveys, Sept 2002

30. Prevention Strategies: To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention Reduce cost of medications with the potential to retard progression of ESRD Free access to full text publications to strengthen academic nephrology. Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia) Support and advise in the design of epidemiologic studies

31. Source: www.uniceflac.org 2000/indicadores) % of the population that lives on less than 1 USA $ per day (International Poverty Line) POPULATION BELOW POVERTY LINE IN LATIN AMERICA

33. POPULATION WITHOUT ADEQUATE SANITATION IN LATIN AMERICA In Latin América/Caribbean 104.316.814 inhabitants (21.9% of the total population) do not have adequate sanitation services. (Cidutal Estadísticas Abril 15, 2003) In Canada and USA 0.16%

34. Canada, USA) = 0.02% In Latin América/Caribbean 72.968.187 inhabitants (15.3% of the total population) do not have access to drinkable water. (Cidutal Estadísticas April 15, 2003 POPULATION WITHOUT POTABLE WATER IN LATIN AMERICA

36. Leading 10 selected risk factors as percentage causes of disease burden measured in DALYs WHO. WHR 2002 (LA nations)