Barriers and promoters for acute renal replacement therapy in Latin America.

Abstract

The epidemiology of Acute Kidney Injury (AKI) varies significantly around the world, exhibiting substantial regional disparities. In Latin America, the situation is particularly worrying: the incidence of AKI in hospitalized patients rises to 31%, a considerably higher figure compared to 19% in North America and 25% in Europe. This condition contributes to approximately 2 million deaths annually globally, a tragic outcome often linked to the lack of timely access to Renal Replacement Therapy. In Latin America, AKI-associated mortality in adults reaches an alarming 38.9%, far exceeding the global average of 23.9%.

Despite the severity of the situation, the epidemiological characterization of AKI in Latin America is notoriously insufficient, especially regarding renal replacement therapy. There are significant barriers to optimal provision, including a lack of training in critical nephrology and limited access to infrastructure and supplies for renal replacement therapy, which is often concentrated only in urban centers. The lack of standardized protocols and specific programs for AKI management further exacerbates the problem. Furthermore, the heterogeneity of national health policies negatively impacts the care of AKI.

To address these shortcomings, a series of strategies is proposed, such as the collection of reliable epidemiological data that can guide effective interventions. In parallel, ongoing education and training of healthcare personnel are necessary, suggesting the use of virtual platforms for training in critical care nephrology. A change in health policies that prioritizes AKI and its care is also essential.

The proposed strategies, although they represent a path that is just beginning, can lay the foundation for a scalable framework to improve AKI care globally. Fortunately, there is a growing collaborative momentum within the Latin American nephrology community, generating hope for positive change.