Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, our objective was to analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

This review has two aims: to summarize the evolution of classification criteria for chronic kidney disease (CKD) for diagnosis, prognosis and forecasting population burden of illness; to move the discussion beyond classification to intervention by introducing an approach we describe as the 'Systematic Approach for the Management of CKD' (SAM-CKD). There is now ample evidence against the use of estimated GFR (eGFR) as the sole criterion for classifying CKD for the purpose of diagnosis, risk stratification and prediction of progression. There is ample evidence that significant proteinuria is a powerful predictor of progression but even more so when combined with reduced eGFR for individual and population risk projection. Hypertension also is an important indicator in CKD progression but not in all studies. Beyond classification, there are no studies addressing standardization of management of CKD to achieve the outcomes articulated by any of the practice guidelines. In this article we have moved the discussions of CKD beyond classification by introducing a clinical management tool, SAM-CKD, which couples a broader classification model with a systematic tool for management to foster standardization of CKD management for the future.

Purpose. To verify the actions and degree of progress achieved in countries of Latin America and the Caribbean in the implementation of the Sustainable and Tenable Renal Health Model promoted by the Latin American Society of Nephrology and Hypertension (SLANH), together with local societies and the participation of the Pan-American Health Organization. (PAHO/WHO). Method The implementation of workshops (e.g., “Toward a Sustainable and Tenable Renal Health Model”) in each country involving health ministries, social security agencies, PAHO, scientific societies, medical organizations, and NGOs, among others, as well as start-up conferences with a special emphasis on local problems. Working teams will state the bases for planning, programming and evaluation in the Logical Framework Matrix and Matrix of Activities and Resources in the First Level of Care. The signature of the document “Declaration” with commitments undertaken by both public and private parties and a work schedule are required. Results. So far, eleven countries in the region have conducted workshops and started activity in the frame of the Model/Program of Renal Health, which articulates the traditional vertical programs and generates a cross-program in the First Level of Care. Its components and strategies make up a cost-efficient control of cardiovascular, renal and endocrine-metabolic health. Conclusion. The Renal Health Model and its program is being built into public health care policies of countries in Latin America and the Caribbean and adapted to the needs of each country with an increasing acceptance on the part of health care professionals. It should not be implemented in isolation but within the framework of non transmissible diseases.

Introducción: La Diálisis Peritoneal (DP) es el procedimiento medico en el que se eliminan los desechos y el líquido excedente en la sangre, esta terapia conlleva una activa labor de autocuidado por parte del paciente en el domicilio, previo entrenamiento de enfermería fomentando la adherencia al tratamiento. Objetivo: describir la relación de cuidado que lleva a cabo la enfermera de diálisis peritoneal de una unidad renal basada en guías y protocolos establecidos, con la teoría de Autocuidado (teoría de los sistemas) de Dorotea Orem. Materiales y métodos: para la realización de este estudio se aplicó un diseño de investigación descriptiva con enfoque cualitativo, participaron 6 enfermeras que laboraban en un programa de Diálisis peritoneal, además, se consultó bibliografías y así relacionar la situación con los modelos y teorías en enfermería. Resultados: El personal de enfermería planificó el entrenamiento al paciente creando estrategias educativas que favorecían el autocuidado según el modelo de Dorotea Orem. Conclusiones: Teniendo en cuenta los conceptos teóricos de Dorotea Orem, aplicados en el cuidado de enfermería en el paciente de Dialisis Peritoneal se logró resultados óptimos en el desarrollo de la terapia del paciente, fortaleciendo la capacidad de autocuidado, desarrollando habilidades y conocimientos que le permitan adherirse a las recomendaciones de enfermería dadas en el entrenamiento.