Socioeconomic determinants on the supply and access to kidney replacement therapies in Latin America

Santiago Torales, Comité de Economía, Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), Montevideo, Uruguay
Laura Cortés-Sanabria, Comité de Economía, Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), Montevideo, Uruguay
Alejandra Ferrari, Comité de Economía, Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), Montevideo, Uruguay
Florencia Rossi, Departamento de Investigación, Agencia de Evaluación de Tecnologías Sanitarias de Uruguay (AETSU), Montevideo, Uruguay
María Oliver, Departamento de Investigación, Agencia de Evaluación de Tecnologías Sanitarias de Uruguay (AETSU), Montevideo, Uruguay

Objective: The increasing global incidence of end-stage chronic kidney disease implies renal replacement therapies (RRT) as critical elements of the financial balance of healthcare systems: their access and distribution are inefficient, with a predominance of less cost-effective techniques, where the supply follows market logic and not public health criteria. Latin America is a region with socioeconomic characteristics where asymmetries and inequalities present a particular panorama. This article tries the impact of selected socioeconomic determinants on the supply and access to RRT in Latin America and identify areas for improvement and research in health policies. Materials and methods: Correlation analysis of 28 variables of supply and access to RRT and socioeconomic determinants from relevant databases (2019-2020) from 19 countries. Results: Access variables (overall prevalence and prevalence by RRT) showed positive correlations with the full range of modalities, early initiation of programs, and the advancement of procurement laws, along with greater urban concentration and economic development indicators (GDP per capita). The supply of professionals and services is uneven, with greater concentration in richer countries, early initiation of Nephrology, greater urban population, and income equality, with a higher prevalence of hemodialysis units over peritoneal dialysis and transplantation. Conclusions: Multiple correlations were found between socioeconomic determinants and RRT access and supply variables, some known and explicit, and others that open the field for research in equitable health policies.

Keywords: Renal replacement therapies. Socioeconomic factors. Health care policies.