The practice of dialysis in the developing countries.

There are few organized data on the practice of dialysis in developing countries, mostly because of a lack of renal registries. The economic, human, and technical resources required for long-term dialysis make it a major economical and political challenge. Most countries do not have not well-formed policies for treatment of end-stage renal disease. The dialysis facilities are grossly inadequate, and there are no reimbursement schemes to fund long-term dialysis. Hemodialysis units are mostly in the private sector and consist of small numbers of refurbished machines. Water treatment is frequently suboptimal, and this problem has led to a number of complications. Hepatitis B and C infections are widespread in dialysis units. Continuous ambulatory peritoneal dialysis (CAPD) seems to be the ideal dialysis option for patients living in remote areas, but high costs preclude its widespread usage. The Mexican experience suggests that even after it becomes affordable, CAPD needs to be used judiciously. Inadequate dialysis, infections, and malnutrition account for the high mortality among the dialysis population in developing countries. Acute peritoneal dialysis using rigid stylet-based catheters is the main form of dialysis in remote areas. Pediatric dialysis units are almost nonexistent. A significant lack of resources exists in developing countries, making the provision of highly technical and expensive care like dialysis a challenge.