The cost barrier to renal replacement therapy and peritoneal dialysis in the developing world.

The socioeconomic statuses of developing nations are diverse. Government policies for reimbursement or coverage of treatment for end-stage renal failure vary greatly from one country to another. Clearly, treatment rates correlate with the gross domestic product and the decision-making process for choosing a specific renal replacement modality is highly influenced by non medical factors. Particularly, those non medical factors include cost issues and the availability of medical and technical resources. Developing nations are experiencing an "epidemiologic transition" as birth rates drop and their populations age. That change in population demographics will undoubtedly increase even further the number of patients at risk of developing end-stage renal disease. Those nations will need to summon the commitment to devote a higher percentage of their resources to treating end-stage renal disease. Finally, when a modality is clearly better for a particular patient, medical indications should play a larger role in the final decision. That approach may prove to be highly useful not only in terms of cost effectiveness and long-term results for the health system, but also in terms of a better quality of life for the patient.