End-Stage Renal Disease in Mexico

Summary End-stage renal disease (ESRD) represents a serious public health problem in Mexico. It is reported among the 10 leading causes of death, and it is the second cause of years of life lost to premature death in the country. Over 65,000 patients are on dialysis. Mexico is among the countries with the highest incidence and prevalence of treated ERSD in the world [421 per million population (pmp)], and it has experienced one of the greatest proportionate increases of ESRD (122%) over the last decade. Although continuous ambulatory peritoneal dialysis continues to be a frequent modality of treatment in Mexico, hemodialysis has experienced a significant growth in recent years. The introduction of legislation on organ donation and transplantation in 1984 resulted in a significant increase in kidney transplantation rates from 1.57 pmp in 1984 to 22.8 pmp in 2015. Similarly, organ and tissue donation rate increased from 6.4 pmp in 2006 to 16 pmp in 2015. The fragmentation of our health care system has resulted in unequal access to renal replacement therapy. Although patients with social security have universal access to renal replacement therapy, it is severely restricted or nonexistent in patients without it. It is of paramount importance to consider ESRD a public health priority in Mexico. Renal care should include prevention programs, as well as dialysis and transplantation. An effort should be made to decentralize the dialysis programs and to promote transplantation as the treatment of choice. The extension of Seguro Popular to cover ESRD treatment nationwide and the implementation of community, chronic kidney disease targeted-screening programs, offer an opportunity to enhance the prevention and control of ESRD in Mexico.