Extracorporeal Blood Purification Therapies in Latin America: Bridging Gaps in Availability and Training

Socioeconomic and developmental diversity across Latin America (LA) significantly affects the availability of extracorporeal blood purification (EBP) therapies to treat acute kidney injury (AKI) and the training of nephrology fellows in these technologies. This survey assessed the availability of EBP therapies and perceived training needs of nephrologists and intensivists in the region.

The aim of this study was to evaluate the availability of EBP therapies to treat AKI and identify training needs among LA nephrologists and intensivists.

Between March and December 2024, the AKI and extracorporeal organ support therapy committee of SLANH conducted an online survey targeting nephrologists and intensivists. The survey gathered data on the availability of EBP technologies in their institutions and perceived training needs.

A total of 505 responses were collected, with 93% submitted by nephrologists. Participants represented 20 LA countries, primarily from South America (58%), Mexico (23.6%), and the Caribbean (10.1%). Intermittent hemodialysis (IHD) was the most widely available therapy, accessible in 98% of centers. Peritoneal dialysis (PD) was available in 65% of hospitals, while continuous renal replacement therapy (CRRT) in 59% of centers but reported as unavailable in Haiti, Nicaragua, Paraguay, and Venezuela. Therapeutic plasma exchange (TPE) was available in 60% of hospitals, although accessibility varied significantly by country. Multi-organ support therapies showed limited regional availability, including liver support (11.9%), extracorporeal membrane oxygenation (ECMO, 16.7%), extracorporeal CO₂ removal (ECCO₂R, 7%), and hemoadsorption (20.6%). The greatest perceived training needs were identified for ECMO (54.2%), ECCO₂R (51.3%), CRRT (48.7%), and TPE (46.8%), whereas demand for further training in IHD and PD was comparatively lower. These findings underscore substantial disparities in therapy access and highlight urgent regional priorities for advanced EBP training.

This study highlights significant disparities in EBP therapy availability across LA, with advanced modalities such as CRRT and multi-organ support largely inaccessible in several countries. Additionally, there is a high perceived need for training in ECMO, ECCO₂R, CRRT, and TPE. Addressing these gaps requires expanding access to EBP, implementing standardized training programs, establishing regional centers of excellence, and fostering international collaboration. Policy advocacy and increased resource allocation will be essential to improving access and optimizing patient outcomes across the region.