Coverage of Patients in Renal Replacement Therapy in Paraguay (2010-2022). The Importance of patient registration

Abstract

Introduction: A patient registry is defined as an organized system that uses methods of observational studies to collect uniform data (clinical or other type), is helpful to achieve scientific, clinical, or health policy purposes predetermined. In 2015, the Pan American Health Organization/Organization World Health Organiza- tion (PAHO/WHO) and the Latin American Society of Nephrology and Hyperten- sion (SLANH) called to prevent chronic kidney disease and improve access to treatment, there being a significant inequity in access to treatment for chronic kidney disease in our region, with a clear disadvantage for countries and lower-income populations. The specific goal for chronic kidney disease is "to achieve a rate of TRR prevalence of at least 700 patients per million population (pmp) for 2019." for this, the strengthening of the National Dialysis Registries is needed and Kidney Transplant. Formulation of Laws or Regulations that guarantee reports mandatory in each country and each health system, formation of multisectoral commissions, and allocation of economic and human resources to ensure the "data capture, en- try, and analysis." In countries like Paraguay, where health investment is very low at 6.8 GDP, the out-of-pocket spending remains around 60%. Health coverage is 19.4% social security, 72.9% MSP and BS (without insurance), 7.7% private insu- rance (without coverage for dialysis).

Objective: To visualize the increase in patient coverage in TRR from 2010 to 2021 in Paraguay and analyze the causes of the progress in coverage. Data are taken from the n ational registry of dialysis and transplantation in Paraguay. Paraguay began to have records in 2010; according to data from the National Institute of Nephrology of the MSP and BS, the national registry was created by ministerial de- cree in February 2018. Twenty-two years of patient records in TRR were analyzed and divided into groups of 2010 -2014 and 2015-2020.

Results: In 2010, the ppm was 130 patients/million inhabitants, and in 2020. We reached 357 Ppm, which decreased in 2021 to 350ppm (an increase of 220ppm). Note that the rise in this ppm is based mainly on the increase in the number of patients on dialysis, while kidney transplantation increases so little.

Conclusions: The national registry was created, but it was not financially suppor- ted. There is a 185% increase in ppm coverage in TRR patients, currently 350 ppm, which is still far from the 700-ppm target. In the years 2010-2014, the total increased by 35%. In the years 2015 to 2021, 45% of which we relate to the intervention of the SLANH/PAHO, raising awareness about the coverage gap for chronic kidney patients in other Latin American countries. Encouraging society‘s nephrology and, above all, our government‘s need to create a national registry of dialysis and trans- plantation and increase coverage of these patients.