Diabetic Kidney Disease Deaths Rising in Latin America

Over the past 20 years, overall mortality rates from diabetes in the American continent have remained stable, but most Latin American countries have seen an increase in mortality rates from diabetes-associated kidney disease, according to new research.

The impact is believed to result from difficulties in accessing quality healthcare, as recounted in the study by the Pan American Health Organization (PAHO) that was published in the International Journal of Epidemiology. Rather than declining, the trend could increase in the coming years, prompting health authorities to demand urgent measures to respond.

“The results are concerning and highlight the urgency of improving the quality of diabetes healthcare, especially in primary healthcare where the majority of our population is treated,” study author Carmen Antini Irribarra, MD, regional advisor for diabetes prevention and control at PAHO, told Medscape Spanish edition.

“The increase in mortality from diabetic kidney disease in almost all countries of the region presents us with a multilevel challenge, where the availability and access to quality health services for diabetes and diabetic kidney disease, including dialysis and kidney transplantation, play a fundamental role,” she added.

The evidence arises from the analysis of epidemiological data from 33 countries in the American continent from 2000 to 2019. This information is available in the World Health Organization’s Global Health Estimates.

Challenges in Latin America

“It is very interesting to observe how the evolution of mortality regarding the diagnosis of diabetes has been analyzed. We see that one of the main challenges we face is the management of one of the most common complications: Kidney disease associated with diabetes,” said Lilia Rizo, MD, professor of internal medicine at Christus Muguerza Alta Especialidad Hospital at the University of Monterrey in San Pedro Garza Garcia, Mexico. Rizo, who did not participate in the study, works as an internist and nephrologist and is a member of the Mexican Council of Nephrology.

The research also highlights the profound differences in diabetes and diabetic kidney disease mortality between the various countries that make up the American continent. In relation to this finding, Rizo noted that, in the region, diabetes and associated kidney disease can overwhelm healthcare systems.

“We have programs that do not cover the complications of diabetic kidney disease or chronic kidney disease: For example, in treatments such as renal replacement therapy. In Mexico, there is not enough supply for so many patients. This happens even for nephrology consultations.”

Martín Mamberti, MD, who also did not participate in the study, is an internist and nephrologist at the General Acute Interzonal Hospital San Martín de La Plata, Argentina, and professor at of medical sciences at the National University of La Plata, Argentina.

He emphasized that “diabetic nephropathy is still a huge challenge for public health since, despite great advances in treatments, its incidence continues to increase in our country. Furthermore, its presence constitutes a risk factor for the development of cardiovascular morbidity and mortality.”

He opined that the study is “extremely interesting and graphic regarding the epidemiological situation of diabetes and diabetic kidney disease in our continent.” But he noted that the study has a basic limitation: The disparity in the quality of the data provided by the countries. He observed that the underreporting of mortality from type 2 diabetes is often much more significant in Latin America than in the United States or Canada.

“This variability is very difficult to homogenize and tends to conceal causes of death related to diabetes other than diabetic nephropathy, such as cardiovascular disease, stroke, or infectious diseases,” said Mamberti.

Therefore, he considered that “the result of this analysis could be taken as a floor for mortality, with the actual mortality associated with diabetes being still difficult to estimate. This could be up to 30% more than what is reported here.”

Strengthening Healthcare Systems 

“This and other types of epidemiological studies are required to assess health status and have an approximation of the quality of care,” said Antini. “They serve as a basis for recommendations that PAHO makes as part of technical cooperation and help ministries to design health policies according to the needs of their populations.” 

PAHO maintains that to improve the control of diabetic kidney disease, it is essential to improve prevention and control of its cause: Diabetes. That is why PAHO is implementing the World Health Organization’s Global Diabetes Compact.

In 2023, the initiative “Better Care for Noncommunicable Diseases” was launched. Its fundamental purpose is to expand equitable access to integrated and comprehensive health services.

The program focuses on primary healthcare, and according to PAHO, it represents a milestone in strengthening the response to noncommunicable diseases, including diabetes.

Rizo agreed on the need for greater involvement of primary care in Latin America. She believes that efforts there would allow patients to adopt healthy lifestyles, receive earlier diagnoses, use effective oral medications in a timely way, and reduce the need for renal replacement therapies.

“The current problem is that when we diagnose kidney disease associated with diabetes, sometimes it’s already too late. And we can’t make interventions that stop the progression of the disease or even reverse it,” she said.

Mamberti also considered primary care to be of vital importance and recalled its role in managing diabetes and kidney disease, which is the early control of other cardiovascular risk factors. Moreover, he emphasized the importance of having greater access to new drugs for clinical practice. Besides improving glycemic control, the drugs reduce complications, achieve lower cardiovascular mortality, and have a nephroprotective profile.

“The Americas region is multifaceted, multiethnic, and multicultural, and that is part of our wealth, our identity. But it shows differences in access levels and in the quality of healthcare services. Furthermore, it is likely that the results of our study reflect weaknesses in diabetes control, in the prevention of its complications, and in supporting self-care,” said Antini.

The authors of the study declared no relevant financial conflicts of interest. Rizo and Mamberti declared no relevant financial conflicts of interest. 

This story was translated from the Medscape Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.