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Cullis B, McCulloch M, Finkelstein FO. Development of PD in lower-income countries: a rational solution for the management of AKI and ESKD. Kidney Int 2024; 105:953-959. [PMID: 38431214 DOI: 10.1016/j.kint.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/26/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024]
Abstract
It is estimated that >50% of patients with end-stage kidney disease (ESKD) in low-resource countries are unable to access dialysis. When hemodialysis is available, it often has high out-of-pocket expenditure and is seldom delivered to the standard recommended by international guidelines. Hemodialysis is a high-cost intervention with significant negative effects on environmental sustainability, especially in resource-poor countries (the ones most likely to be affected by resultant climate change). This review discusses the rationale for peritoneal dialysis (PD) as a more resource and environmentally efficient treatment with the potential to improve dialysis access, especially to vulnerable populations, including women and children, in lower-resource countries. Successful initiatives such as the Saving Young Lives program have demonstrated the benefit of PD for acute kidney injury. This can then serve as a foundation for later development of PD services for end-stage kidney disease programs in these countries. Expansion of PD programs in resource-poor countries has proven to be challenging for various reasons. It is hoped that if some of these issues can be addressed, PD will be able to permit an expansion of end-stage kidney disease care in these countries.
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Affiliation(s)
- Brett Cullis
- Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Pediatrics, Hilton Life Hospital, Hilton, South Africa
| | - Mignon McCulloch
- Department of Medicine, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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2
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Tan J, Liew A, Koh D. Clinical outcomes and performance indicators of patients with Kidney Failure and Acute Kidney Injuries in ASEAN countries. Nephrology (Carlton) 2022; 27:739-752. [PMID: 35661340 DOI: 10.1111/nep.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This review article reports clinical outcomes and performance indicators of patients with Kidney Failure (KF) and Acute Kidney Injuries (AKI) in Association of South East Asian Nations (ASEAN) countries. METHODOLOGY ASEAN data, segregated by income status, from national registries and literature were collated, compared and benchmarked against international references. RESULTS The national incidence and prevalence of treated KF ranged from 172-479 per million population (pmp) and 36-2255 pmp respectively. Brunei (79%), Malaysia (66%) and Singapore (66%) had world-leading proportions of diabetes-related KF. Haemodialysis (HD), Peritoneal Dialysis (PD) and transplant accounted for 68-100%, 0-27% and 0-18% of all Kidney Failure Replacement Therapy respectively. Transplant patient survival were superior with 90-93% at five years and 71-90% at 10 years, compared to PD (44-54%) and HD (53-64%) at five years. Higher-income countries were able to achieve good anaemia control, HD and PD adequacy targets, whilst usage of arteriovenous fistula in HD varied from 70-85%. Acute Kidney Injury (AKI) rates ranged from 24.2-49.2% of high-dependency admissions. Lower incidences of PD peritonitis and HD Catheter-related Bloodstream Infections; and PD-favouring quality-of-life were evident in higher-income countries. CONCLUSION ASEAN has a challenging burden of kidney disease, with extremely high incidence, prevalence, DM-related KF and AKI rates. The magnitude of the prevailing problem calls for the creation of a regional society under the auspices of ASEAN with a shared perspective of universal, equitable and charitable access to quality renal care; consistent with the founding premises and healthcare initiatives of ASEAN. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jackson Tan
- Department of Nephrology, Ripas Hospital / Universiti Brunei Darussalam, Brunei Darussalam
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - David Koh
- NUS Saw Swee Hock School of Public Health, Singapore
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Kusirisin P, Srisawat N. Hemodiafiltration in developing countries. Semin Dial 2022; 35:449-456. [PMID: 35352848 DOI: 10.1111/sdi.13077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
Hemodiafiltration (HDF) is a promising kidney replacement therapy modality for patients with end-stage kidney disease. The principle of uremic toxin clearance by combining convection and diffusion can lead to greater benefits compared to conventional hemodialysis. Evidence is building that supports the advantages of HDF with short-term outcomes such as greater intradialytic hemodynamic stability, improved nutritional status, attenuation of anemia, and reduction of inflammatory cytokines which produce improved key long-term impacts including survival and cardiovascular outcomes. Very little is known about the prevalence of HDF treatments in developing countries due to a shortage of national kidney registries. HDF experience is limited in many countries due to the cost of dialysis treatments, availability of online HDF machines, and reimbursement policies. These obstacles have led to nephrologists developing innovations, for example, convective control HDF (CC-HDF), simple mid-dilution, and simple mixed-dilution methods, which may be as effective as commercially available HDF machines. In this article, we will focus on the experience of HDF practice and barriers to adoption in developing countries. Results can guide clinical practice recommendations for implementing HDF in resource-limited settings.
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Affiliation(s)
- Prit Kusirisin
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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Ethier I, Johnson DW, Bello AK, Ye F, Osman MA, Levin A, Harris DCH, Kerr P, Liew A, Wong MG, Lunney M, Saad S, Zaidi D, Khan M, Jha V, Tonelli M, Okpechi IG, Viecelli AK. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Oceania and South East Asia. Kidney Int Suppl (2011) 2021; 11:e86-e96. [PMID: 33981474 DOI: 10.1016/j.kisu.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022] Open
Abstract
Oceania and South East Asia (OSEA) is a socioeconomically, culturally, and ethnically diverse region facing a rising epidemic of noncommunicable diseases, including chronic kidney disease (CKD). The second iteration of the International Society of Nephrology Global Kidney Health Atlas aimed to provide a comprehensive evaluation of kidney care in OSEA. Of the 30 countries/territories in OSEA, 15 participated in the survey, representing 98.5% of the region's population. The median prevalence of treated kidney failure in OSEA was 1352 per million population (interquartile range, 966-1673 per million population), higher than the global median of 787 per million population. Although the general availability, access, and quality of kidney replacement therapy (i.e., dialysis and transplantation) was high in OSEA, inequalities in accessibility and affordability of kidney replacement therapy across the region resulted in variability between countries. According to the survey results, in a third of the participating countries (mostly lower-income countries), less than half the patients with kidney failure were able to access dialysis, whereas it was readily available to all with minimal out-of-pocket costs in high-income countries; similar variability in access to transplantation was also recorded. Limitations in workforce and resources vary across the region and were disproportionately worse in lower-income countries. There was little advocacy for kidney disease, moderate use of registries, restricted CKD detection programs, and limited availability of routine CKD testing in some high-risk groups across the region. International collaborations, as seen in OSEA, are important initiatives to help close the gaps in CKD care provision across the region and should continue receiving support from the global nephrology community.
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Affiliation(s)
- Isabelle Ethier
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Kerr
- Nephrology, Monash Medical Centre, Victoria, Australia
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Muh Geot Wong
- Department of Renal Medicine, Royal North Shore Hospital, University of Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
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Sahay M, Ismal K, Vali PS. Hemodialysis at Doorstep - "Hub-and-Spoke" Model of Dialysis in a Developing Country. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:840-849. [PMID: 32801246 DOI: 10.4103/1319-2442.292319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
End-stage kidney disease has become a huge burden in our country. There has been an increase in dialysis centers across the country. State-funded dialysis has been initiated in many states of India. However, most of the centers are concentrated in the cities. Patients living in the peripheral districts have to travel long distance to reach the dialysis centers. In addition, there is a dearth of nephrology services in the peripheral areas. To address this problem, the hub-and- spoke model of dialysis has been initiated in Telangana state in South India, which has brought dialysis at the doorstep for people residing in remote districts. This study highlights the important features of this model.
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Affiliation(s)
- Manisha Sahay
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
| | - Kiranmai Ismal
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
| | - P Sharmas Vali
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
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Chan-On C, Sarwal MM. A Comprehensive Analysis of the Current Status and Unmet Needs in Kidney Transplantation in Southeast Asia. Front Med (Lausanne) 2017; 4:84. [PMID: 28691007 PMCID: PMC5481314 DOI: 10.3389/fmed.2017.00084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/06/2017] [Indexed: 01/24/2023] Open
Abstract
To address the unmet needs in the face of a growing demand for end-stage renal failure management and kidney transplantation in Asia, we have conducted a critical analysis of published literature and national registries to evaluate clinical outcomes and the rates of organ donation in Southeast Asia and the challenges facing these regions with regards to regulation, choice of donor source, and funding. Based on the available data, suggestions are proposed for an advancement of rates of organ donation and access, with emphasis on improved regulation and public education.
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Affiliation(s)
- Chitranon Chan-On
- Division of Nephrology, Faculty of Medicine, Department of Internal Medicine, Khon Kaen University, Khon Kaen, Thailand.,Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Minnie M Sarwal
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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Hyodo T, Hirawa N, Hayashi M, Than KMM, Tuyen DG, Pattanasittangkur K, Hu LW, Naramura T, Miyamoto K, Yamashita AC. Present status of renal replacement therapy at 2015 in Asian countries (Myanmar, Vietnam, Thailand, China, and Japan). RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-016-0082-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Li PKT, Chow KM, Van de Luijtgaarden MWM, Johnson DW, Jager KJ, Mehrotra R, Naicker S, Pecoits-Filho R, Yu XQ, Lameire N. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 2016; 13:90-103. [PMID: 28029154 DOI: 10.1038/nrneph.2016.181] [Citation(s) in RCA: 323] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. In many countries, patient outcomes with peritoneal dialysis are comparable to or better than those with haemodialysis, and peritoneal dialysis is also more cost-effective. These benefits have not, however, always led to increased utilization of peritoneal dialysis. Use of this therapy is increasing in some countries, including China, the USA and Thailand, but has proportionally decreased in parts of Europe and in Japan. The variable trends in peritoneal dialysis use reflect the multiple challenges in prescribing this therapy to patients. Key strategies for facilitating peritoneal dialysis utilization include implementation of policies and incentives that favour this modality, enabling the appropriate production and supply of peritoneal dialysis fluid at a low cost, and appropriate training for nephrologists to enable increased utilization of the therapy and to ensure that rates of technique failure continue to decline. Further growth in peritoneal dialysis use is required to enable this modality to become an integral part of renal replacement therapy programmes worldwide.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol &Richard Yu PD Research Centre, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Carol &Richard Yu PD Research Centre, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Moniek W M Van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, Netherlands
| | - David W Johnson
- Department of Nephrology, Division of Medicine, ARTS Building, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, Netherlands
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, 325 9th Avenue, BOX 359606, Seattle, Washington 98104, USA
| | - Sarala Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | | | - Xue Qing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Norbert Lameire
- University Hospital Gent, 185, De Pintelaan, BE-9000 Gent, Belgium
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Prasad N, Jha V. Hemodialysis in Asia. KIDNEY DISEASES 2015; 1:165-77. [PMID: 27536677 DOI: 10.1159/000441816] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/18/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Asia is the largest, most populous and most heterogeneous continent in the world. The number of patients with end-stage renal disease is growing rapidly in Asia. SUMMARY A fully informed report on the status of dialysis therapies including hemodialysis (HD) is limited by the lack of systematic registries. Available data suggest remarkable heterogeneities, with some countries like Taiwan, Japan and Korea exhibiting well-established HD systems, high prevalence and universal access to all patients, while low- and low-middle income countries are unable to provide HD to eligible patients because of high cost and poor healthcare systems. Many Asian countries have unregulated dialysis units, with poor standards of delivery, quality control and outcome reporting. This leads to high mortality due to preventable complications like infections. Modeling data suggest that at least 2.9 million people need dialysis in Asia, which represents a gap in availability of dialysis to the tune of -66%. The population is projected to grow rapidly in the coming years. Several countries are expanding access to HD. Innovative modifications in dialysis practice are being made to optimize outcomes. It is important to develop robust systems of documentation and outcome reporting to evaluate the effects of such changes. HD needs to develop in conjunction with effective preventive programs and improvement of health systems. KEY MESSAGES The practice of HD in Asia is growing and evolving. Rapid expansion will improve the currently dismal access to care for large sections of the population. Quality issues need to be addressed if the full benefit of this therapy is to reach the population. Developed countries of Asia can provide substantial messages to developing economies. HD programs must develop in conjunction with prevention efforts. FACTS FROM EAST AND WEST (1) While developed Western and Asian countries provide end-stage renal disease patients full access to HD, healthcare systems from South and South-East Asia can offer access to HD only to a limited fraction of the patients in need. Even though the annual costs of HD are much lower in less developed countries (for instance 30 times lower in India compared to the US), patients often cannot afford costs not covered by health insurance. (2) The recommended dialysis pattern in the West is at least three sessions weekly with high-flux dialyzers. Studies from Shanghai and Taiwan might however indicate a benefit of twice versus thrice weekly sessions. In less developed Asian countries, a twice weekly pattern is common, sometimes with dialyzer reuse and inadequate water treatment. A majority of patients decrease session frequency or discontinue the program due to financial constraint. (3) As convective therapies are gaining popularity in Europe, penetration in Asia is low and limited by costs. (4) In Asian countries, in particular in the South and South-East, hepatitis and tuberculosis infections in HD patients are higher than in the West and substantially increase mortality. (5) Progress has recently been made in countries like Thailand and Brunei to provide universal HD access to all patients in need. Nevertheless, well-trained personnel, reliable registries and better patient follow-up would improve outcomes in low-income Asian countries.
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Affiliation(s)
- Narayan Prasad
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India; George Institute for Global Health, New Delhi, India
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