The medical knowledge changes continuously based on new research findings that have implications for the management of patients. How these advances will be translated into clinical practice is a matter of ongoing debate in the different levels of decision making in medicine. The use of clinical guidelines by the health professional can establish a rational management of the patient, based on the latest findings in the field and on existing experience.

During the last two decades numerous clinical practice guidelines have been written and published in diverse specialties of medicine. They all have a common denominator: to standardize medical practice according to current knowledge and according to the availability and needs of each area of ​​medicine in each region.

The challenge to produce a guide is not small. It involves many hours of work of recognized researchers, consensus meetings in various places, usually away from the sites of origin of these professionals, and a financial investment destined to overcome these meetings and the publication of them. This last point is perhaps the key to success or failure of this important work. Making guides that are able to reach all professionals related to the topic, easily understood, crossing barriers of interpretation and language, and finally that can be adapted to local realities of each country and region is often a point of enormous value.

Latin America is a huge region of the world that comprises more than 20 countries who speak 3 languages ​​and numerous dialects, whose racial origins date back to a mixture of indigenous and colonial immigration, mainly from Spain and Portugal, in the fifteenth century. Beside the geographic and ethnic variety we add political, economic and social diversity. In the same region coexist countries with an annual GDP per capita close to U$D 18,000 and others with less than U$D 1500. These same differences exist in the population´s access to education and health.

Nephrology is no exception to this reality. Almost parallel to the economic level of the country is the renal patient access to medical care. The number of nephrologists and the prevalence and incidence of dialysis patients, depends on the level of development of the country.

The Latin American Society of Nephrology and Hypertension (SLANH) has developed the "Guidelines of clinical practice for the prevention, diagnosis, evaluation and treatment of the bone and mineral disorders in chronic kidney disease (CKD-TMO). They were drafted by the Committee of bone and mineral metabolism of SLANH and were based on KDIGO guidelines (Clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) and recommendations published by the Society of Nephrology of Argentina, Brazil, Mexico and Uruguay.

This clinical practice guideline of the SLANH emphasize the biochemical evaluation of disorders of mineral metabolism, the current utility of bone biopsy as a gold standard for diagnosing of renal osteodystrophy, the forms to detect vascular calcification as a result of MOM disorders, and the medical or invasive management of these pathologies adapted to the local possibilities. The immediate mission remains to make them reach each of the professionals involved with the care of patients with kidney disease in Latin America, even though in many cases this care does not have the ideal resources for this purpose.

Dr. Walter Douthat

SLANH President-elect

Click here to read the Guidelines on the SLANH Website