Dominican Republic Kidney Replacement Therapy: What the National Registry Shows

The first nationwide epidemiological analysis of kidney replacement therapy in the Dominican Republic provides something the country has lacked for years: a consolidated picture of patients whose kidney function has deteriorated far enough to require chronic dialysis. Published in BMC Nephrology, the study analyzed data from the Dominican National Dialysis Registry for 2022 and identified 4,690 patients receiving chronic hemodialysis or peritoneal dialysis. The findings show a health system heavily dependent on hemodialysis, a very high prevalence of hypertension among registered patients, and a substantial burden of diabetes. They also reveal important geographic and data-quality issues that complicate any attempt to translate the registry into a broader estimate of kidney disease in the Dominican population.

What the National Dialysis Registry Study Investigated

The study by Cáceres-Murillo and colleagues was designed as a nationwide, observational, descriptive, cross-sectional analysis of the Dominican Republic’s National Dialysis Registry. The registry was established in 2020 under Ministerial Resolution No. 00011, which made reporting of patients receiving chronic hemodialysis or peritoneal dialysis in authorized facilities mandatory.

For the study, researchers analyzed information corresponding to the 2022 calendar year. Data were collected between August and September 2023 through a standardized digital questionnaire completed by medical and administrative personnel at dialysis centers. The researchers examined demographic characteristics, dialysis modality, health insurance status, reported diabetes and hypertension, selected viral serology, residual urine output, medication use and aspects of vascular access and dialysis-related complications.

The registry covered 114 Ministry of Public Health-authorized dialysis centers. Of those centers, 110 submitted data, producing a reported response rate of 96.4%. The researchers used the records supplied by the centers to characterize the national dialysis population and calculated the number of registered patients receiving kidney replacement therapy per million inhabitants using the country’s official 2022 population estimate.

Because the study was descriptive, the researchers did not perform hypothesis testing or statistical imputation of missing data. That distinction matters. The study was intended primarily to describe the population recorded in the national registry, not to establish causal relationships between risk factors and kidney failure or to estimate the prevalence of chronic kidney disease throughout the country.

Who Was Recorded in the Registry?

The registry contained 4,690 patients receiving chronic kidney replacement therapy in 2022. Their median age was about 56 years, and 68.7% were men. The population therefore consisted predominantly of middle-aged and older adults, although the registry methodology included both adult and pediatric patients.

More than half of the registered patients were covered through contributory health insurance, while 33.7% were listed under subsidized insurance. Another 9.7% were recorded in a combined category for private insurance or uninsured status, and 5.8% had insurance information unavailable or not reported. The study cautions that the private and uninsured categories could not be separated because they were combined in the original registry form.

These figures are important because dialysis is not simply a clinical issue. It is also a long-term health-system commitment requiring regular treatment, specialized infrastructure, medicines, vascular or peritoneal access, transportation and sustained insurance or public financing. The registry’s insurance profile provides a glimpse of that connection, although it does not by itself measure the financial burden experienced by individual patients or households.

Hemodialysis Dominates Kidney Replacement Therapy

The most striking therapeutic finding was the dominance of hemodialysis. Of the 4,690 registered patients, 3,677, or 78.4%, were receiving hemodialysis. The remaining 1,013 patients, or 21.6%, were receiving peritoneal dialysis.

Hemodialysis filters waste products and excess fluid from the blood through an external dialysis machine. Peritoneal dialysis uses the patient’s peritoneal membrane inside the abdomen as the filtering surface, with dialysis fluid introduced through a catheter. Both are established forms of kidney replacement therapy, but they require different infrastructure, patient support systems and clinical expertise.

The study found that continuous ambulatory peritoneal dialysis, or CAPD, was the dominant form of peritoneal dialysis, accounting for 80.4% of patients receiving PD. The remaining patients used automated peritoneal dialysis. The prominence of CAPD means that most PD patients in the registry were using a method based on repeated exchanges of dialysis solution rather than relying primarily on a machine to perform the exchanges.

The researchers argue that the relatively small share of peritoneal dialysis deserves attention when planning future kidney care. They describe PD as a potentially cost-effective modality that can offer advantages for decentralized care and accessibility. That is an interpretation and policy implication of the study, rather than evidence that one modality is universally superior to the other.

What the Study Found About Dialysis Access

For patients receiving hemodialysis, the type of vascular access is an important clinical indicator because repeated access to the bloodstream is required. Among the 3,677 hemodialysis patients, an arteriovenous fistula was the predominant access, reported in 61.2% of cases. The study identified both autologous and prosthetic fistulas, with autologous fistulas accounting for the larger share.

Catheters accounted for much of the remaining vascular access. The study reported tunneled and non-tunneled catheters separately and examined infectious complications associated with vascular access. Sixty-two percent of hemodialysis patients had no reported infectious episodes during the study period, while the remainder had one or more reported episodes.

These findings should not be interpreted as a direct measure of national dialysis quality. The researchers note that the data were reported by individual centers and that some variables were not standardized sufficiently to allow reliable international comparisons. Nevertheless, the information is useful because it establishes a national baseline against which future registry reports could track changes in vascular access and complications.

Hypertension and Diabetes Were the Main Reported Comorbidities

The clearest clinical signal in the registry was the exceptionally high prevalence of hypertension. The study reported hypertension in 4,404 patients, or 93.9% of the registered cohort. Diabetes mellitus was reported in 2,084 patients, equivalent to 44.4% of the total.

Diabetes was more frequently reported among patients receiving peritoneal dialysis than among those receiving hemodialysis: 52.5% versus 42.2%. The study describes diabetes and hypertension as comorbid conditions, not necessarily as the primary causes of kidney failure in individual patients. That distinction is essential because the registry did not contain sufficiently complete information on the underlying etiology of kidney failure to establish how many cases were directly caused by either condition.

The findings nevertheless fit into a much broader international picture. The World Health Organization estimates that chronic kidney disease affects about 674 million people worldwide, while the 2023 Global Burden of Disease analysis estimated that 788 million adults aged 20 or older were living with chronic kidney disease in 2023. High blood pressure, high blood glucose and elevated body mass index are among the major risk factors associated with the global burden of CKD.

For the Dominican Republic, the practical implication is not that every case of kidney failure can be prevented. Rather, the registry reinforces the importance of managing conditions that can damage the kidneys long before dialysis becomes necessary. The Ministry of Public Health has likewise emphasized prevention and early detection of chronic kidney disease and has identified diabetes, hypertension, obesity, smoking and cardiovascular disease as important risk factors.

The Registry Does Not Measure National Kidney Disease Prevalence

One of the most important points for readers is also one of the easiest to misunderstand. The study’s 4,690 registered patients are not equivalent to the number of people in the Dominican Republic who have chronic kidney disease.

The registry records people receiving chronic kidney replacement therapy through hemodialysis or peritoneal dialysis. Chronic kidney disease exists across a much wider spectrum, from early disease that may be detected through blood or urine testing to advanced kidney failure requiring dialysis or transplantation. The World Health Organization notes that chronic kidney disease can be detected through relatively simple blood and urine tests, while kidney failure is the stage at which dialysis or transplantation may be required to sustain life.

The study calculated 421.8 registered patients receiving kidney replacement therapy per million inhabitants in 2022, including 330.7 per million for hemodialysis and 91.1 per million for peritoneal dialysis. These are registry-based treatment figures, not estimates of the prevalence of chronic kidney disease among the general population.

This distinction is particularly important in a country where early-stage kidney disease may not be captured by a dialysis registry. A person with reduced kidney function who is being treated through medication, dietary management and monitoring is not represented in the 4,690-patient figure simply because that person has not reached kidney failure requiring chronic dialysis.

Where Were Dialysis Patients Concentrated?

The geographic distribution of registered patients was highly uneven. The National District accounted for 37.1% of the recorded dialysis population, while Santiago de los Caballeros accounted for another 24.2%. Other areas, including Santo Domingo Province, La Vega, Puerto Plata and San Pedro de Macorís, represented considerably smaller shares.

The study also calculated population-adjusted figures by province and found substantial variation. The National District had a reported rate of 1,690.8 registered dialysis patients per million inhabitants, while Santiago had 1,057.1 per million. By contrast, Santo Domingo Province had 129.6 per million in the study’s provincial calculation.

These differences should not automatically be interpreted as proof that kidney failure is more common in one province than another. The authors explicitly point to the unequal distribution of dialysis facilities and the concentration of health infrastructure in major urban centers. Patients may therefore travel from areas with fewer facilities to cities where dialysis is available.

In other words, the geography of the registry partly reflects the geography of healthcare access. A patient living in a rural or peripheral area may be counted at a dialysis center located in a major urban area, while a province with limited local capacity may appear to have fewer registered patients than expected from its population alone.

Why the Findings Matter for the Dominican Health System

The study matters because kidney replacement therapy is one of the clearest points at which chronic disease becomes a long-term health-system challenge. Patients requiring dialysis need recurring treatment and coordinated access to specialized personnel, equipment, medicines and clinical monitoring. The larger the dialysis population becomes, the greater the need for reliable planning of facilities, staffing and financing.

The Dominican health authorities have already developed policies aimed at addressing kidney disease earlier in its progression. The Ministry of Public Health published a clinical management guide for chronic kidney disease stages 1 through 3A for use in first-level healthcare facilities. Its emphasis on primary care is significant because prevention and early detection occur well before a patient reaches the stage of kidney failure represented in the national dialysis registry.

The Ministry has also reported that chronic kidney disease remains under epidemiological surveillance in the country, including individual notification of stage V chronic kidney failure. This surveillance function and the dialysis registry serve related but distinct purposes: one can help identify disease at the population level, while the other describes people receiving chronic kidney replacement therapy.

SeNaSa, the Dominican Republic’s state health insurer, also operates a kidney-disease follow-up program. Its institutional reporting describes monitoring of subsidized-regime members with hypertension and diabetes who have risk factors for kidney damage, alongside management of patients receiving hemodialysis. The program includes measures such as laboratory testing, medication and supplies, vascular fistula management and coordination of dialysis services.

For insured patients more broadly, SISALRIL, the Superintendence of Health and Labor Risks, identifies dialysis and kidney transplantation among high-cost services covered under the Dominican health insurance system. SISALRIL has also stated that coverage includes both hemodialysis and peritoneal dialysis under the applicable health plans.

What the Study Says About Prevention

The study does not test whether better control of hypertension or diabetes would reduce dialysis rates in the Dominican Republic, so it cannot establish that causal relationship from its own data. However, the exceptionally high proportion of registered patients with hypertension and the large proportion with diabetes are consistent with the established role of these conditions as major drivers of kidney disease worldwide.

The prevention message therefore begins before dialysis. Regular management of blood pressure and diabetes, appropriate testing for kidney damage in people at risk, and timely clinical follow-up can help identify chronic kidney disease earlier. The Dominican Ministry of Public Health has similarly emphasized healthy behaviors, prevention and early detection as part of its response to renal disease.

The global context makes that strategy increasingly important. A 2025 analysis published in The Lancet estimated that 788 million adults worldwide were living with chronic kidney disease in 2023 and identified high fasting glucose, body mass index and systolic blood pressure among the leading risk factors for CKD-related disability. The World Health Organization has also warned that kidney disease is becoming an increasingly important cause of death globally.

How Kidney Replacement Therapy Fits Into the Larger Treatment Path

Kidney replacement therapy is generally used when kidney function has deteriorated severely. It does not represent the beginning of kidney disease; it represents advanced disease requiring a method of replacing some of the functions normally performed by the kidneys.

Hemodialysis performs filtration outside the body through a dialysis machine. Peritoneal dialysis performs filtration inside the body using the peritoneal membrane. Kidney transplantation is another form of kidney replacement therapy in the broader clinical sense because a functioning donor kidney can replace lost renal function, although transplantation was not part of the dialysis population analyzed in this registry study.

This distinction is relevant when interpreting the 4,690-patient figure. The study specifically examined patients receiving chronic hemodialysis or peritoneal dialysis in authorized facilities. It should not be read as a census of every Dominican patient living with kidney failure, including people with functioning kidney transplants.

The Dominican health system has also continued to develop transplant coverage. SISALRIL reports that the annual coverage limit for kidney transplantation was increased to RD$3.5 million under the applicable national health insurance framework. Such coverage is part of the broader renal-care continuum, but the study’s registry data do not allow an assessment of how many dialysis patients ultimately receive transplants or how long patients remain on dialysis.

The Registry’s Most Important Limitations

The study is described as the first nationwide epidemiological analysis of the Dominican dialysis registry, but the authors are careful about what the data can and cannot establish. The first major limitation is that the information was reported by dialysis centers. Even though 110 of 114 authorized centers submitted information, self-reported data can contain omissions or differences in data quality between facilities.

Second, four authorized centers did not submit data. The researchers therefore could not guarantee complete national capture, even though the response rate was high. This means that the registry provides a strong national picture but should not be treated as an absolutely complete census without qualification.

Third, the study was cross-sectional. It describes the population at a particular point in time but does not follow individual patients over years. As a result, it cannot provide reliable conclusions about survival, long-term outcomes, technique failure, changes between dialysis modalities or the probability that an individual patient will receive a transplant.

Fourth, the registry did not contain sufficiently complete information on the primary causes of kidney failure. This is particularly important because the presence of diabetes or hypertension in a patient does not prove that either condition caused that patient’s kidney failure.

Finally, some clinical variables were not standardized enough for robust international comparison. The authors specifically note that infectious complications were not defined in a sufficiently standardized way to calculate a comparable peritonitis rate for peritoneal dialysis. These limitations are not minor technical details: they determine which conclusions can responsibly be drawn from the registry.

What the Dominican Republic Still Needs to Know

The national registry has created an important foundation, but its future value will depend on how consistently and comprehensively it develops. A stronger registry could eventually provide more detailed information on the causes of kidney failure, patient outcomes, mortality, hospitalization, technique failure, transplantation, changes between dialysis modalities and differences in care across geographic areas.

Longitudinal patient identifiers would be particularly valuable because they could allow researchers to follow patients over time without exposing personal information. The study authors identify this type of development, along with standardized variables and stronger data validation, as priorities for future versions of the registry.

More complete information would also help policymakers distinguish between two very different questions: how many people require kidney replacement therapy and how many people are developing kidney disease that could potentially be detected or managed before reaching kidney failure. The dialysis registry is well suited to the first question. It cannot, by itself, answer the second.

What the Registry Tells Us — and What It Does Not

The Dominican Republic’s national dialysis registry has moved kidney replacement therapy from a fragmented area of health information toward a more measurable national picture. The 2022 data show a dialysis population of 4,690 recorded patients, predominantly men, with hemodialysis accounting for nearly four out of every five cases. Hypertension affected almost the entire registered population, while diabetes affected more than two in five patients.

The findings also point to a broader policy challenge. The most important response to kidney failure cannot begin only when dialysis starts. It has to extend through primary care, where hypertension, diabetes and other risk factors can be detected and managed, and through systems capable of identifying kidney damage before it becomes irreversible.

At the same time, the registry should not be used to claim that 4,690 people represent the total burden of kidney disease in the Dominican Republic. The study’s value lies precisely in its narrower definition: it is a national description of patients receiving chronic dialysis. Its next challenge is to become more complete, more standardized and more longitudinal so that future researchers and policymakers can understand not only who is receiving treatment, but also why patients are reaching kidney failure, how outcomes differ across the country and where earlier intervention could make the greatest difference.

For international readers, the central lesson is straightforward. The Dominican Republic now has a national evidence base showing the scale and characteristics of its chronic dialysis population. The numbers do not establish the national prevalence of kidney disease, but they do show that advanced kidney failure is a significant health-system issue closely intertwined with hypertension, diabetes, access to specialized care and the capacity to detect disease before dialysis becomes necessary.

Primary scientific source: PubMed — National dialysis registry of the Dominican Republic: first nationwide epidemiological analysis of renal replacement therapy.

Additional institutional context: Dominican Ministry of Public Health, SISALRIL, SeNaSa, and the World Health Organization.