[Advanced chronic kidney disease and end-stage kidney disease in Latin America: Gaps in continuity of care, the strategic role of kidney transplantation, and challenges for health governanceDoença renal crônica avançada e terminal na América Latina: lacunas no continuum de cuidados, papel estratégico do transplante renal e desafios para a governança em saúde].

Objective: To describe the epidemiological and health care situation of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Latin America; identify strengths and gaps in early detection, referral, and access to and coverage of renal replacement therapies (RRTs); contextualize these findings in light of the recent WHO Resolution WHA78.6 on kidney health and propose recommendations. Methods: A special report was prepared using a structured narrative approach based on a descriptive and comparative analysis of regional and global secondary data sources published over the past six years. Information was organized into four categories: 1) timely detection and referral; 2) access to and cost of RRTs;3) mortality and structural inequalities; and 4) availability and quality of national registries. Results: Latin America has a high prevalence of CKD and CKD-associated mortality that exceeds the global average, accompanied by marked disparities, deficiencies in timely referral to nephrology services, and a high proportion of unplanned dialysis initiations. Hemodialysis is far more common than peritoneal dialysis and kidney transplantation, even though the latter is the most cost-effective option and yields the best outcomes in terms of survival and quality of life. There are limitations in financial coverage and in the availability of comprehensive national registries. Conclusions: These findings highlight persistent structural shortcomings in kidney care across Latin America while also providing a basis for the development of specific, prioritized recommendations. The evidence reviewed underscores the need to strengthen kidney health governance, improve early detection and timely referral, ensure equitable and sustainable access to RRTs, strategically prioritize kidney transplantation, and consolidate interoperable information systems as a foundation for reducing mortality and inequality across the Region.