Latin America is a vast region of primarily middle- and low-income countries with approximately 660 million people who share a Latin extraction and language (Spanish or Portuguese). The area exhibits extreme diversity in socioeconomic status and access to quality health care. The prevalence of chronic kidney disease (CKD) seems to be growing in Latin America (1). Population aging, suboptimal treatment of comorbidities such as hypertension, and the growing epidemic of type 2 diabetes affect many people in this region. In addition, Latin Americans often live in poverty and follow unhealthy diets, lack physical exercise, and have precarious working conditions (1). Moreover, this population faces difficulties receiving medical care, most often provided by public health systems that struggle with financial constraints.
Cancer incidence is increasing in Latin America, with rising rates of common cancer types, such as breast, prostate, and colorectal cancers (2). Larger countries, such as Brazil, report approximately 620,000 new cancer cases per year. Although significant progress in cancer registries has been made in the last 5 years, quality is heterogeneous because several countries do not have reliable cancer data. Also, the overall population-based cancer coverage in Latin America is 23.3% compared with 98% in North America. Many Latin American patients do not have access to cancer-screening examinations (e.g., mammography, cervical cancer screening, and colonoscopy), leading to delays in cancer diagnosis or access to essential cancer treatments, such as surgery, standard chemotherapy, and palliative care. Furthermore, there is a particular shortage of radiotherapy services. Also, practical strategies to reduce cancer incidence, such as human papillomavirus vaccination, are not broadly available in most Latin American countries (2). Cancer treatment is usually concentrated in tertiary centers located in large metropolitan areas where nephrology training and kidney care of cancer patients typically occur.
Many Latin American patients do not have access to cancer-screening examinations … leading to delays in cancer diagnosis or access to essential cancer treatments.
CKD is common in patients with cancer, and cancer treatment contributes to CKD development and progression. Additionally, CKD has been recognized as a significant risk factor for cancer development and reduced specific cancer survival (3). In Latin American countries, the burden of cancer-associated CKD likely overlaps with local epidemiological determinants (e.g., diabetes, hypertension, and Mesoamerican nephropathy).
Onconephrology is a rapidly expanding field, considered the latest frontier in the fight against kidney diseases. Thanks to a worldwide effort, led mainly through data from North America and Europe, a considerable amount of information has accumulated in the last few years, improving kidney care and hopefully the prognosis of patients with cancer. In Latin America, onconephrology research and education are not yet as well developed, and clinical practice is not as well structured as in high-income countries. Key starting points should include educational and research initiatives (Table 1). With these initiatives in place, we might be able to improve kidney outcomes of patients with cancer in Latin America in the coming years.
Initiatives for onconephrology education and research in Latin America
Cusumano AM, González Bedat MC. Chronic kidney disease in Latin America: Time to improve screening and detection. Clin J Am Soc Nephrol 2008; 3:594–600. doi: 10.2215/CJN.03420807
Barrios CH, et al. Cancer control in Latin America and the Caribbean: Recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474–e487. doi: 10.1016/S1470-2045(21)00492-7
Hassan I, Perazella M. Onco-nephrology: An appraisal of the cancer and chronic kidney disease links. Nephrol Dial Transplant 2015; 1–10. doi: 10.1093/ndt/gfu387