Eleven years of chronic hemodialysis in Uruguay: mortality time course

Uruguay is a developing country with 3.1 million inhabitants. Chronic dialysis treatment (CDT) began to spread after the creation of the National Fund of Resources (NFR) in 1980. This fund receives contribution from all inhabitants to finance, among others, the high cost treatment, dialysis and renal transplantation (RT). We analyzed the data base from 1981 to 1991 of the Hemodialysis National Registry to find the mortality time course. To compare with other populations, indirect standardization methods were used. Two thousand and seventy-one patients received chronic hemodialysis treatment (CHT) during the period cited. Incidence and prevalence of end-stage renal disease (ESRD) increased from 32 to 90 and from 38 to 390 patients per million population, respectively. Annual gross mortality decreased from 21 to 9% in spite of a simultaneous increase in the percentage of high risk patients. According to the age-matched national general mortality, the ratio between observed and expected deaths was 21 in 1981 and 4 in 1991. The standardized death rate was 142.8 deaths/1000 patient-years at risk when the USA ESRD 1987 to 1989 mortality rate by age, race and diagnosis was used as a standard. These results point out that it is possible to provide ESRD treatment in developing countries to achieve appropriate comparative results in delaying mortality.