- Email: [email protected]
Global kidney disease – Authors' reply
Correspondence
1
2
Luyckx V, Naicker S, Mckee M. Equity and economics of kidney disease in sub-Saharan Africa. Lancet 2013; 382: 103–04. Zevallos L, Pastor R, Moscoso B. Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps. Rev Peru Med Exp Salud Pública 2011; 28: 177–85.
I read with interest Vivekanand Jha and colleagues’ report (July 20, p 260)1 on chronic kidney disease. For Venezuela, the data published were incorrect and do not reflect the situation in the country. In their figure 2,1 the causes of chronic kidney disease in Venezuela are diabetes, chronic interstitial glomerulonephritis, and hypertensive glomerulosclerosis. Bellorin-Font and colleagues 2 reported in 2002 that diabetes, glomerular diseases, and hypertension account for more than 60% of the patients in chronic dialysis; however, the contribution of each disease was not reported. According to the latest available official data (from 2007), the causes of chronic kidney disease in Venezuela are: diabetes (30%), hypertensive glomerulosclerosis (21%), unknown (17·2%), chronic glomerulonephritis (12·8%), others (8·3%), and chronic interstitial glomerulonephritis (6·3%). It is regrettable and disappointing that official data are not largely available. The Renal Health Programme (Ministerio del Poder Popular de la Salud de Venezuela) is working diligently to resolve this important issue. There have been few papers published regarding kidney diseases in Venezuela, and they were mostly focused on Venezuelan indigenous populations.3 Two epidemics of acute post-streptococcal glomerulonephritis (in 1968 and 1974) have been reported by Rodriguez-Iturbe and Musser.4 Finally, since 2007, diabetes and hypertensive glomerulosclerosis continue to be the leading causes of chronic kidney failure in dialysis 1244
patients in Venezuela—both diseases representing 55% of the causes of kidney failure in these patients. I declare that I have no conflicts of interest.
Raul Carlini [email protected] Renal Health Programme, Ministerio del Poder Popular de la Salud, Caracas 1050, Venezuela 1
2
3
4
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013; 382: 260–72. Bellorin-Font E, Milanes Cl, Rodriguez-Iturbe B. End-stage renal disease and its treatment in Venezuela. Artif Organs 2002; 26: 747–49. Bellorin-Font E, Pernalete N, Meza J, Milanes CL, Carlini RG. Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela. Kidney Int Suppl 2005; 97: S18–22. Rodriguez-Iturbe B, Musser JM. The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol 2008; 19: 1855–64.
Authors’ reply We thank Raul Carlini for his interest in our paper,1 and for providing the data on distribution of the causes of end-stage kidney disease in Venezuela. Accurate data on incidence, prevalence, and causes of end-stage kidney disease are difficult to obtain for large parts of the developing world.1 The absence of such data does not allow for accurate international comparisons and prevents healthcare officials and policy makers from prioritising efforts for prevention and provision of care to these patients. We agree that information on the relative contributions of different causes to the end-stage kidney disease population in Venezuela is not available. This paucity of information for developing countries prompted Rashad Barsoum to collect data from leading nephrologists in different countries for his 2002 overview.2 For our report, data for Venezuela were based on Barsoum’s2 and Bellorin-Font and colleagues’ data,3 which identified diabetes, hypertension, and chronic glomerulonephritis as the main causes of end-stage kidney disease. Cusumano and González Bedat,4 using data of the Latin American Dialysis and Transplant Registry (which covers 97% of the region’s population), reported diabetes to be the cause of
end-stage kidney disease in 42% of the dialysis population in Venezuela in 2006. The frequency of other causes was not provided. We thank Carlini for providing updated information. As in most parts of the developing world, the emergence of diabetes as the main cause of chronic kidney disease is notable. Although there is a decline in the proportion of cases due to chronic glomerulonephritis, the absolute numbers are likely to have been unchanged or even increased, given the increase in the end-stage kidney disease incidence rates. Management of end-stage kidney disease is expensive and places disproportionate burden on patients’ families, societies, and health-care systems.5 This reinforces the need to screen individuals with diabetes for early signs of kidney disease as per guidelines and implement effective measures to prevent disease onset or attenuate disease progression. The efforts of the Government of Venezuela to collect data on the incidence, prevalence, and causes of end-stage kidney disease are laudable. Other countries should develop methods to collect data and make them available in the public domain. We declare that we have no conflicts of interest.
*Vivekanand Jha, Guillermo Garcia-Garcia [email protected] George Institute for Global Health, New Delhi, India (VJ); and Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Mexico (GG-G) 1
2
3
4
5
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013; 382: 260–72. Barsoum RS. Overview: end-stage renal disease in the developing world. Artif Organs 2002; 26: 737–46 Bellorin-Font E, Milanes Cl, Rodriguez-Iturbe B. End-stage renal disease and its treatment in Venezuela. Artif Organs 2002; 26: 747–49. Cusumano AM, González Bedat MC. Chronic kidney disease in Latin America: time to improve screening and detection. Clin J Am Soc Nephrol 2008; 3: 594–600. Ramachandran R, Jha V. Kidney transplantation is associated with catastrophic out of pocket expenditure in India. PLoS One 2013; 8: e67812.
www.thelancet.com Vol 382 October 12, 2013
1
2
Luyckx V, Naicker S, Mckee M. Equity and economics of kidney disease in sub-Saharan Africa. Lancet 2013; 382: 103–04. Zevallos L, Pastor R, Moscoso B. Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps. Rev Peru Med Exp Salud Pública 2011; 28: 177–85.
I read with interest Vivekanand Jha and colleagues’ report (July 20, p 260)1 on chronic kidney disease. For Venezuela, the data published were incorrect and do not reflect the situation in the country. In their figure 2,1 the causes of chronic kidney disease in Venezuela are diabetes, chronic interstitial glomerulonephritis, and hypertensive glomerulosclerosis. Bellorin-Font and colleagues 2 reported in 2002 that diabetes, glomerular diseases, and hypertension account for more than 60% of the patients in chronic dialysis; however, the contribution of each disease was not reported. According to the latest available official data (from 2007), the causes of chronic kidney disease in Venezuela are: diabetes (30%), hypertensive glomerulosclerosis (21%), unknown (17·2%), chronic glomerulonephritis (12·8%), others (8·3%), and chronic interstitial glomerulonephritis (6·3%). It is regrettable and disappointing that official data are not largely available. The Renal Health Programme (Ministerio del Poder Popular de la Salud de Venezuela) is working diligently to resolve this important issue. There have been few papers published regarding kidney diseases in Venezuela, and they were mostly focused on Venezuelan indigenous populations.3 Two epidemics of acute post-streptococcal glomerulonephritis (in 1968 and 1974) have been reported by Rodriguez-Iturbe and Musser.4 Finally, since 2007, diabetes and hypertensive glomerulosclerosis continue to be the leading causes of chronic kidney failure in dialysis 1244
patients in Venezuela—both diseases representing 55% of the causes of kidney failure in these patients. I declare that I have no conflicts of interest.
Raul Carlini [email protected] Renal Health Programme, Ministerio del Poder Popular de la Salud, Caracas 1050, Venezuela 1
2
3
4
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013; 382: 260–72. Bellorin-Font E, Milanes Cl, Rodriguez-Iturbe B. End-stage renal disease and its treatment in Venezuela. Artif Organs 2002; 26: 747–49. Bellorin-Font E, Pernalete N, Meza J, Milanes CL, Carlini RG. Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela. Kidney Int Suppl 2005; 97: S18–22. Rodriguez-Iturbe B, Musser JM. The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol 2008; 19: 1855–64.
Authors’ reply We thank Raul Carlini for his interest in our paper,1 and for providing the data on distribution of the causes of end-stage kidney disease in Venezuela. Accurate data on incidence, prevalence, and causes of end-stage kidney disease are difficult to obtain for large parts of the developing world.1 The absence of such data does not allow for accurate international comparisons and prevents healthcare officials and policy makers from prioritising efforts for prevention and provision of care to these patients. We agree that information on the relative contributions of different causes to the end-stage kidney disease population in Venezuela is not available. This paucity of information for developing countries prompted Rashad Barsoum to collect data from leading nephrologists in different countries for his 2002 overview.2 For our report, data for Venezuela were based on Barsoum’s2 and Bellorin-Font and colleagues’ data,3 which identified diabetes, hypertension, and chronic glomerulonephritis as the main causes of end-stage kidney disease. Cusumano and González Bedat,4 using data of the Latin American Dialysis and Transplant Registry (which covers 97% of the region’s population), reported diabetes to be the cause of
end-stage kidney disease in 42% of the dialysis population in Venezuela in 2006. The frequency of other causes was not provided. We thank Carlini for providing updated information. As in most parts of the developing world, the emergence of diabetes as the main cause of chronic kidney disease is notable. Although there is a decline in the proportion of cases due to chronic glomerulonephritis, the absolute numbers are likely to have been unchanged or even increased, given the increase in the end-stage kidney disease incidence rates. Management of end-stage kidney disease is expensive and places disproportionate burden on patients’ families, societies, and health-care systems.5 This reinforces the need to screen individuals with diabetes for early signs of kidney disease as per guidelines and implement effective measures to prevent disease onset or attenuate disease progression. The efforts of the Government of Venezuela to collect data on the incidence, prevalence, and causes of end-stage kidney disease are laudable. Other countries should develop methods to collect data and make them available in the public domain. We declare that we have no conflicts of interest.
*Vivekanand Jha, Guillermo Garcia-Garcia [email protected] George Institute for Global Health, New Delhi, India (VJ); and Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Mexico (GG-G) 1
2
3
4
5
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013; 382: 260–72. Barsoum RS. Overview: end-stage renal disease in the developing world. Artif Organs 2002; 26: 737–46 Bellorin-Font E, Milanes Cl, Rodriguez-Iturbe B. End-stage renal disease and its treatment in Venezuela. Artif Organs 2002; 26: 747–49. Cusumano AM, González Bedat MC. Chronic kidney disease in Latin America: time to improve screening and detection. Clin J Am Soc Nephrol 2008; 3: 594–600. Ramachandran R, Jha V. Kidney transplantation is associated with catastrophic out of pocket expenditure in India. PLoS One 2013; 8: e67812.
www.thelancet.com Vol 382 October 12, 2013