Kidney International, Vol. 68, Supplement 97 (2005), pp. S58–S61 Renal replacement therapy among disadvantaged populations in Mexico: A report from the Jalisco Dialysis and Transplant Registry (REDTJAL) GUILLERMO GARCIA-GARCIA, J. FRANCISCO MONTEON-RAMOS,HECTOR GARCIA-BEJARANO, BENJAMIN GOMEZ-NAVARRO,IMELDA HERNANDEZ-REYES,ANA MARIA LOMELI,MIGUEL PALOMEQUE,LAURA CORTES-SANABRIA,HUGO BREIEN-ALCARAZ, and NORMA M. RUIZ-MORALES Renal replacement therapy among disadvantaged populations in Mexico: A report from the Jalisco Dialysis and Transplant Registry (REDTJAL). Background. End-stage renal disease represents a serious public health problem in Jalisco, Mexico. It is reported among the 10 leading causes of death, with an annual mortality rate of 12 deaths per 100,000 population. The state population is 6.3 million, and more than half do not have medical insurance. In this study, we report the population’s access to renal replace- ment therapy (RRT). Methods. Patients ≥15 years of age, who started RRT be- tween January 1998 and December 2000 at social security or health secretariat medical facilities, were included. Nine facil- ities participated in the study. At the start of treatment, the patient’s facility, age, gender, cause of renal failure, and initial treatment modality were registered. Results. Within the study period, 2456 started RRT, 1767 (72%) at social security facilities and 687 (28%) at health sec- retariat facilities, for an annual incidence rate of 195 per million population (pmp). The main cause of renal failure was diabetes mellitus (51% of patients). There were significant differences between the 2 populations. Patients with social security were older (53.1 ± 17 vs. 45.1 ± 20 years, P = 0.001) and had more di- abetes (54% vs. 42%, P = 0.001) than those without social secu- rity. They had higher acceptance (327 pmp vs. 99 pmp, P = 0.001) and prevalence rates (939 pmp vs. 166 pmp, P = 0.001) than pa- tients without medical insurance. Dialysis use was similar in both populations. Eighty-five percent of patients were on con- tinuous ambulatory peritoneal dialysis and 15% on hemodial- ysis. Kidney transplant rate was higher among insured patients (72 pmp vs. 7.5 pmp, P = 0.001). The number of dialysis pro- grams and nephrologists that offered renal care also differed. There were 10 dialysis programs in social security and 3 in health secretariat facilities. Fourteen nephrologists looked after the in- sured population, whereas 5 cared for the uninsured (7.7 pmp vs. 2.1 pmp, P = 0.001). The latter had access to 8 hemodialysis stations compared with 34 for the insured population (3.4 pmp vs. 18.8 pmp, P = 0.001). Conclusions. Access to RRT is unequal in our state. Although it is universal for the insured population, it is severely restricted for the poor. Social and economical factors, as well as the lim- Key words: dialysis, access, insurance, transplant, poverty. C  2005 by the International Society of Nephrology ited number of understaffed, centralized dialysis facilities, could explain these differences. Resumen Antecedentes. La insuficiencia renal cr ´ onica representa un serio problema de salud p ´ ublica en el estado de Jalisco. Se en- cuentra entre las 10 causas m ´ as frecuentes de muerte con una tasa de 12 fallecimientos por 100,000 habitantes. Nuestro es- tado cuenta con una poblaci ´ on de 6.3 millones de habitantes y m´ as de la mitad de ellos no cuentan con seguridad social. En el presente estudio reportamos el acceso de ellos a terapias de reemplazo renal (TRR). M´ etodos. Se incluyeron pacientes ≥ 15 a˜ nos de edad que iniciaron TRR entre Enero de 1998 y Diciembre de 2000 en instituciones de la seguridad social y de la Secretar´ıa de Salud. Nueve instituciones participaron en el estudio. A su ingreso se registraron la instituci ´ on, edad, g ´ enero, causa de la falla renal y el tipo de terapia inicial. Resultados. En el periodo de estudio, 2,456 iniciaron TRR, 1,767 (72%) en la seguridad social y 687 (28%) en la institu- ciones de la Secretar´ıa de Salud, para una incidencia anual de 195 por mill ´ on de habitantes (pmh). La principal causa de falla renal fue la diabetes mellitus (51% de los casos). Se observaron diferencias importantes entre las dos poblaciones. Los pacientes con seguridad social ten´ıan m´ as edad (53.1 ± 17 vs 45.1 ± 20 a˜ nos, P = 0.001) y m´ as diabetes (54% vs 42%), P = 0.001) que los no asegurados. Su acceso a di´ alisis (327 vs 99 pmh, P = 0.001) y su prevalencia (939 vs 166 pmh, P = 0.001) fue mayor que los pacientes sin seguro m ´ edico. La utilizaci ´ on de di´ alisis fue similar en los dos grupos; 85% se encontraban en di´ alisis peritoneal continua ambulatoria y 15% en hemodi ´ alisis. La tasa de trasplante fue mayor en pacientes con seguridad so- cial que en los no asegurados (72 vs 7.5 trasplantes pmh, P = 0.001). En total, el n ´ umero de programas de di ´ alisis y el n ´ umero de nefr ´ ologos para la atenci ´ on de los dos grupos, tambi´ en fue diferente. Mientras que los pacientes con seguridad social ten´ıan acceso a 10 programas, solo exist´ıan 3 para los no asegurados. 14 nefr ´ ologos atend´ıan a los asegurados, mientras que solo 5 atend´ ıan a los no asegurados (7.7 vs 2.1 pmh, P = 0.001). Estos ´ ultimos ten´ıan acceso a 8 estaciones de di´ alisis, comparado con 34 para la poblaci ´ on asegurada (3.4 vs 18.8 pmh, P = 0.001). Conclusiones. El acceso a las TRR en nuestro estado no es eq- uitativo. Mientras que es universal para la poblaci ´ on asegurada, se encuentra muy limitado para la no asegurada. Factores so- ciales y econ ´ omicos, as´ı como el n ´ umero limitado de programas de di ´ alisis y de nefr ´ ologos, pudieran explicar estas diferencias. S-58