Nephrology in Venezuela

Nephrology in Venezuela started in the early 1960s and developed progressively in the areas of clinical nephrology, dialysis, transplantation, and research. Along the ensuing 50 years, the program, oriented to the attention to the population with renal disease, grew progressively based on well-designed health policies and legal framework according to the advances in nephrology. In terms of health policies, the program evolved from activities centered on the attention to chronic kidney disease to prevention and promotion of renal health. Several studies have shown that endemic and epidemic diseases such as post-infectious glomerulonephritis and malaria are important threats in some regions of the country. Likewise, that risk of chronic kidney disease of different origin is a growing and important problem. In this regard, diabetes and hypertension, and in a lesser degree glomerular diseases, have grown significantly, accounting for more than 60% of the causes of admission to dialysis. Renal replacement therapy programs developed steadily to approach 71.5% of the coverage of 700 pmp suggested by SLANH and OPAS for the population of the Latin America region, thus highlighting the need of joint efforts with other programs such as cardiology and diabetes for prevention and health promotion. Kidney transplant activity gradually increased, particularly in regard to deceased donors, based on public policies for organ procurement and sharing. Parallel to the development of nephrology in the general population, there has been a gradual increase in the attention of kidney disease in the pediatric population, including a better knowledge of the clinical problems affecting children and renal replacement therapies. Financing of renal replacement therapy has been at no cost to the patient. During the last years, all renal replacement therapy programs have been affected by an increasing political, economic, and social crisis that has undermined all health programs. Under this crisis, the total hemodialysis and peritoneal dialysis coverage has decreased in around 29% (19.6% in hemodialysis and 85.6% in peritoneal dialysis), whereas transplant programs have been virtually halted. These deficiencies are aggravated by a marked shortage of immunosuppressive agents to prevent rejection and decrease in specialized human resources. The path to reconstruction of the system looks difficult at this time and will require political stabilization, new policies to rebuild the legal framework, adequate budgets, and motivation and compromise of all human factors involved in patient attention.