Preventing end-stage kidney disease: a personal opinion from the Third World

Pedro L. SantaCruz

Medical Unit ‘Vargas’ Maracay, Estado Aragua Venezuela Email: plsantacruz{at}cantv.net

Sir,

I read with great interest the editorial, by Schieppati, Perico and Remuzzi, which was recently published in NDT [1]. I also enjoyed the special note, written by the editors in chief of both NDT and Kidney International, about the importance of the prior scientific paper [2].

As a Latin American nephrologist, I know the socioeconomic and sanitary status of this region. In recent years, an increase in the prevalence and incidence of end-stage kidney disease (ESKD) has been observed in Latin America and around the world. At the same time, we have witnessed the arrival of more expensive new technologies for renal replacement treatment. In consequence, I have become aware of the necessity for a social projection of nephrology [3]. To achieve this it is vital to establish health programmes to prevent or at least lessen the impact of ESKD in our communities, by screening the general population for renal diseases and risk factors for renal function (principally, diabetes and hypertension) [3,4].

It is, indeed, very satisfying to confirm that we are neither alone nor forgotten in this world and that colleagues of regions with elevated standards of development and better sanitary structures than ours, have perceived the magnitude of the problem and have proposed possible solutions. One of the most relevant ideas expressed in the paper was that ‘the magic bullet that is indispensable to cure most of the problem is money’ [1].

I firmly support the creation of a global fund to fight renal diseases. But, as was stated in July 2002 in the Lancet [5], ‘without supporting biomedical and health-sciences research on the problems facing the world’s poor, the long-term value of these global funds will be severely compromised.’ The approach is not easy, it will be large and with a lot of stumbling blocks. However, with determination and tenacity, working together and aiming at the same objective, we can succeed.

I offer my gratitude as a physician, a nephrologist and a researcher in renal epidemiology to the authors of the editorial for their noble purpose. I also thank them as a Latin American and a human being.

Conflict of interest statement. None declared.

References

  1. Schieppati A, Perico N, Remuzzi G. Preventing end-stage renal disease: the potential impact of screening and intervention in developing countries. Nephrol Dial Transplant 2003;18: 858–859[Free Full Text]
  2. Drüeke T, Klahr S. Comment on the editorial by Schieppati et al. Nephrol Dial Transplant 2003;18: 857[Free Full Text]
  3. SantaCruz PL. Chronic renal failure and the necessary social projection of nephrology. Nefrologia 1988;8: 81
  4. SantaCruz PL. Chronic renal failure as health problem: a timely reflection. Nefrologia 2000;20: 465–466[ISI][Medline]
  5. Time to make the Global Fund global. Lancet 2002;360: 181[CrossRef][ISI][Medline]




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