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Sir, I read with great interest the editorial, by Schieppati, Perico and Remuzzi, which was recently published in NDT (1). I also enjoyed the special note, written by the editors in chief of both NDT and Kidney International, about the importance of the prior scientific paper (2). As a Latin American nephrologist, I know the socioeco- nomic and sanitary status of this region. In recent years, an increase in the prevalence and incidence of end-stage kidney disease (ESKD) has been observed in Latin America and around the world. At the same time, we have witnessed the arrival of more expensive new technologies for renal replacement treatment. In consequence, I have become aware of the necessity for a social projection of nephrology (3). To achieve this it is vital to establish health programmes to prevent or at least lessen the impact of ESKD in our communities, by screening the general population for renal diseases and risk factors for renal function (principally, diabetes and hypertension) (3,4). It is, indeed, very satisfying to confirm that we are neither alone nor forgotten in this world and that colleagues of regions with elevated standards of development and better sanitary structures than ours, have perceived the magnitude of the problem and have proposed possible solutions. One of

Preventing end-stage kidney disease: a personal opinion from the Third World