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Kidney disease: forgetting public health

It affects more than 750 million people worldwide. Their load, detection and treatment vary throughout the planet. However, it is neglected in the global health policy agenda.

The situation around worrying kidney disease as, according to the Global Disease Burden study, 1.2 million people died worldwide in 2015 and more than 2 million died in 2010 because they did not have access to dialysis. It may even contribute to more deaths than the top 4 Non-communicable diseases (cardiovascular disease, cancer, chronic respiratory diseases and diabetes).

The complex and costly nature of kidney disease care is linked to public policies and the financial situation of each country. Thus, it is imperative to achieve a preponderant place in global public health agendas, and in Argentina in particular, by allocating the necessary resources for their comprehensive care.

Thus, the most solvent nations, which allocate a higher percentage of GDP in health, improve the dialysis-to-transplant ratio, increasing kidney transplant rates. In addition to genetic, environmental and clinical factors linked to kidney disease, people with low socio-economic status bear the greatest burden.

How Argentina is in that context

In 2016, public spending on health declined by almost 30%, reaching 5.62% of GDP, a drop of 1.2 points from 2015. (datosmacro.com). This is in a context of poverty that reaches one third of the population. Paraguay, Brazil and Uruguay invest a higher percentage of GDP in health than Argentina. In our country, there are currently more than 30,000 dialytic patients and 11% of the population has some degree of kidney disease.

According to the Argentine Register of chronic dialysis (INCUCAI), fewer patients were admitted during 2017 (last published record) than in 2013-2016, in worse conditions and with less prior contact with the nephrologist. They are also getting younger every year, coming in very anaemic, malnourished and without prior medical control. According to the study, this situation is due to the fact that patients do not have access to dialysis or arrive in such poor health conditions that they do not reach treatment.

The lack of funding leads to two alarming phenomena: an increase in the appearance of kidney disease in the population and an increased mortality due to uncontrolled disease conditions. The marked decrease in specialized centres for their treatment worsens the picture. The latter is accentuated and has been denounced on multiple occasions.

In 2008, we anticipated these outcomes for the affected population if the health budget was not corrected. In 2018, we warned about the imminent closure of health centers. Today, we continue to demand a budget commensurate with the magnitude of the disease we face.

Thus, vulnerable individuals suffering from the disease are without diagnosis and without access to diagnosis or treatment, let alone evolutionary control, increasing their morbidity and mortality. Those who still retain a certain economic capacity also do not have specialized centres for their care. We warned him years ago, now it’s happening.

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