Abdou Niang1, Arpana Iyengar2, Valerie A Luyckx3. 1. Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Sénégal. 2. Department of Pediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India. 3. Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Winterthurerestrasse, Zurich, Switzerland.
Abstract
PURPOSE OF REVIEW: To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. RECENT FINDINGS: Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally. SUMMARY: Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.
PURPOSE OF REVIEW: To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. RECENT FINDINGS: Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally. SUMMARY: Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.
Authors: Chih-Wei Yang; David C H Harris; Valerie A Luyckx; Masaomi Nangaku; Fan Fan Hou; Guillermo Garcia Garcia; Hasan Abu-Aisha; Abdou Niang; Laura Sola; Sakarn Bunnag; Somchai Eiam-Ong; Kriang Tungsanga; Marie Richards; Nick Richards; Bak Leong Goh; Gavin Dreyer; Rhys Evans; Henry Mzingajira; Ahmed Twahir; Mignon I McCulloch; Curie Ahn; Charlotte Osafo; Hsiang-Hao Hsu; Lianne Barnieh; Jo-Ann Donner; Marcello Tonelli Journal: Kidney Int Suppl (2011) Date: 2020-02-19
Authors: Mignon McCulloch; Valerie A Luyckx; Brett Cullis; Simon J Davies; Fredric O Finkelstein; Hui Kim Yap; John Feehally; William E Smoyer Journal: Nat Rev Nephrol Date: 2020-10-01 Impact factor: 28.314