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McCarthy FA, Bonilla-Felix M. Advancing equitable access to care and optimal medication practice. World Kidney Day 2024. Pediatr Nephrol 2024; 39:2279-2282. [PMID: 38532035 DOI: 10.1007/s00467-024-06353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Florencio A McCarthy
- Department of Medicine, Pediatric Nephrology Service, Hospital del Niño "Dr. José Renán Esquivel", Panama City, Panama.
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Bauer AC, Elias RM, Abensur H, Batista MC, Jansen AM, Riella MC. Chronic Kidney Disease in Brazil: Current Status and Recommended Improvements. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:213-223. [PMID: 38835403 PMCID: PMC11149994 DOI: 10.1159/000538068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/26/2024] [Indexed: 06/06/2024]
Abstract
Background Over the last 3 decades, over 700 million individuals worldwide have been diagnosed with chronic kidney disease (CKD). In a 2017 survey in southern Brazil, 11.4% of those surveyed had CKD. Early identification and effective therapy in Brazil may reduce CKD's impact. This panel discusses the early diagnosis and treatment of CKD and the barriers and actions needed to improve the management of CKD in Brazil. A panel of Brazilian nephrologists was provided with relevant questions to address before a multiday conference. During this meeting, each narrative was discussed and edited through several rounds until agreement on the relevant topics and recommendations was achieved. Summary Panelists highlighted hurdles to early diagnosis and treatment of CKD. These include, but are not limited to, a lack of public and patient education, updated recommendations, multidisciplinary CKD treatment, and a national CKD database. People-centered, physician-centered, and healthcare institution-centered actions can be taken to improve outcomes. Patient empowerment is needed via multiple channels of CKD education and access to health-monitoring wearables and apps. Primary care clinicians and nonspecialists must be trained to screen and manage CKD-causing illnesses, including diabetes and hypertension. The healthcare system may implement a national health data gathering system, more screening tests, automated test result reporting, and telehealth. Key Messages Increasing access to early diagnosis can provide a path to improving care for patients with CKD. Concerted efforts from all stakeholders are needed to overcome the barriers.
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Affiliation(s)
- Andrea Carla Bauer
- Department of Internal Medicine- Nephrology Division, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rosilene M Elias
- Nephrology Division, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Nephrology Division, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Hugo Abensur
- Nephrology Division, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Nephrology Division, BP-Beneficência Portuguesa, São Paulo, Brazil
| | - Marcelo Costa Batista
- Nephrology Division, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Miguel Carlos Riella
- Nephrology Division, Department of Medicine, Hospital Universitário Evangélico Mackenzie, Curitiba, Brazil
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3
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Cuervo LG, Villamizar CJ, Osorio L, Ospina MB, Cuervo DE, Cuervo D, Bula MO, Zapata P, Owens NJ, Hatcher-Roberts J, Martín EA, Piquero F, Pinilla LF, Martínez-Herrera E, Jaramillo C. Dynamic measurements of geographical accessibility considering traffic congestion using open data: a cross-sectional assessment for haemodialysis services in Cali, Colombia. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100752. [PMID: 38737772 PMCID: PMC11087994 DOI: 10.1016/j.lana.2024.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
Background Many cities with traffic congestion lack accessibility assessments accounting for traffic congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial-temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people's places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility. Methods Cross-sectional analyses of DSTAM, accounting for traffic congestion, were conducted using a web-based platform. This platform integrated traffic analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identified optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-min car drive of a haemodialysis service during peak and free-flow traffic congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020. Findings There were substantial traffic variations. Congestion reduced accessibility, especially among marginalised groups. For 6-12 July, free-flow and peak-traffic accessibility rates were 95.2% and 45.0%, respectively. For 23-29 November, free-flow and peak traffic accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variation and would notably enhance accessibility and health equity. Interpretation Establishing haemodialysis services in targeted areas has significant potential benefits. By increasing accessibility, it would enhance urban health and equity. Funding No external or institutional funding was received.
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Affiliation(s)
| | | | - Lyda Osorio
- School of Public Health, Universidad del Valle, Cali, Colombia
| | | | | | | | | | | | - Nancy J. Owens
- Independent Content and Communications Consultant, Fairfax, VA, USA
| | - Janet Hatcher-Roberts
- School of Epidemiology and Public Health in the Faculty of Medicine, and Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Felipe Piquero
- Patient Advocate and Author of an Autopathography, Bogotá, Colombia
| | | | | | - Ciro Jaramillo
- School of Civil and Geomatic Engineering of the Universidad del Valle, Cali, Colombia
| | - The AMORE Project Collaborationp
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Public Health, Universidad del Valle, Cali, Colombia
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- National Disability Board of Colombia, Bogotá, Colombia
- IQuartil SAS, Bogotá, Colombia
- Independent Researcher, Bogotá, Colombia
- Independent Content and Communications Consultant, Fairfax, VA, USA
- School of Epidemiology and Public Health in the Faculty of Medicine, and Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- Colombian Association of Transplanted Athletes, Bogota, Colombia
- Patient Advocate and Author of an Autopathography, Bogotá, Colombia
- Universidad de la Sabana, Campus del Puente del Común, Chía, Cundinamarca, Colombia
- National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia
- School of Civil and Geomatic Engineering of the Universidad del Valle, Cali, Colombia
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4
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Boateng EA, Iddrisu AA, Kyei-Dompim J, Amooba PA. A qualitative study on the lived experiences of individuals with end-stage kidney disease (ESKD) accessing haemodialysis in Northern Ghana. BMC Nephrol 2024; 25:186. [PMID: 38822254 PMCID: PMC11143648 DOI: 10.1186/s12882-024-03622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 05/27/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Haemodialysis is Ghana's most common form of renal replacement therapy for end-stage kidney disease (ESKD). However, limited research has explored the experiences of individuals with ESKD receiving haemodialysis in relatively poorer regions, especially in the northern part of the country. This study explored individuals' experiences with accessing haemodialysis in northern Ghana and was guided by Levesque's conceptual framework of access to healthcare. METHODS The study utilized a phenomenological design, and participants were recruited through the purposive sampling method. Individuals with ESKD receiving haemodialysis for at least three months were interviewed using a semi-structured interview guide. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability. RESULTS Most of the participants had a history of hypertension that progressed to ESKD due to poor management practices - mainly purchasing antihypertensive drugs over the counter without visits to the hypertensive clinic contributed greatly to the delay in diagnosing ESKD in northern Ghana. The geographical location of the dialysis centre and limited dialysis machines were the key barriers to adequate access to dialysis. Many participants had two dialysis sessions per week instead of thrice a week. Some were even having one session per week due to the distance from their residence to the dialysis centre and the costs involved. CONCLUSION Access to haemodialysis for individuals with ESKD in the northern part of the country is relatively limited in many ways compared with that in the southern part of the country. Health policies should include funding for haemodialysis and a collaboration with pharmaceutical companies to consider manufacturing dialysis concentrates to reduce the cost. Additionally, there should be deliberate efforts to design and implement programs to promote ESKD awareness in the country, especially in relatively poorer regions.
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Affiliation(s)
- Edward Appiah Boateng
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Aduni Amina Iddrisu
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Community Health Nurse's Training College, Navrongo, Ghana
| | - Joana Kyei-Dompim
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Neyra JA, Gewin L, Ng JH, Barreto EF, Freshly B, Willett J, Abdel-Rahman EM, McCoy I, Kwong YD, Silver SA, Cerda J, Vijayan A. Challenges in the Care of Patients with AKI Receiving Outpatient Dialysis: AKINow Recovery Workgroup Report. KIDNEY360 2024; 5:274-284. [PMID: 38055734 PMCID: PMC10914193 DOI: 10.34067/kid.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Up to one third of survivors of AKI that required dialysis (AKI-D) during hospitalization remain dialysis dependent at hospital discharge. Of these, 20%-60%, depending on the clinical setting, eventually recover enough kidney function to stop dialysis, and the remainder progress to ESKD. METHODS To describe the challenges facing those still receiving dialysis on discharge, the AKINow Committee conducted a group discussion comprising 59 participants, including physicians, advanced practitioners, nurses, pharmacists, and patients. The discussion was framed by a patient who described gaps in care delivery at different transition points and miscommunication between care team members and the patient. RESULTS Group discussions collected patient perspectives of ( 1 ) being often scared and uncertain about what is happening to and around them and ( 2 ) the importance of effective and timely communication, a comfortable physical setting, and attentive and caring health care providers for a quality health care experience. Provider perspectives included ( 1 ) the recognition of the lack of evidence-based practices and quality indicators, the significant variability in current care models, and the uncertain reimbursement incentives focused on kidney recovery and ( 2 ) the urgency to address communication barriers among hospital providers and outpatient facilities. CONCLUSIONS The workgroup identified key areas for future research and policy change to ( 1 ) improve communication among hospital providers, dialysis units, and patients/care partners; ( 2 ) develop tools for risk classification, subphenotyping, and augmented clinical decision support; ( 3 ) improve education to providers, staff, and patients/care partners; ( 4 ) identify best practices to improve relevant outcomes; ( 5 ) validate quality indicators; and ( 6 ) assess the effect of social determinants of health on outcomes. We urge all stakeholders involved in the process of AKI-D care to align goals and work together to fill knowledge gaps and optimize the care to this highly vulnerable patient population.
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Affiliation(s)
- Javier A. Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie Gewin
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Jia H. Ng
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine, Hempstead, New York
| | | | | | - Jeff Willett
- ASN: American Society of Nephrology, Washington, DC
| | - Emaad M. Abdel-Rahman
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Ian McCoy
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
| | - Yuenting D. Kwong
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
| | - Samuel A. Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Jorge Cerda
- Division of Nephrology, Department of Medicine, Albany Medical College, Albany, New York
| | - Anitha Vijayan
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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7
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Li H, Li M, Liu C, He P, Dong A, Dong S, Zhang M. Causal effects of systemic inflammatory regulators on chronic kidney diseases and renal function: a bidirectional Mendelian randomization study. Front Immunol 2023; 14:1229636. [PMID: 37711613 PMCID: PMC10498994 DOI: 10.3389/fimmu.2023.1229636] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background While targeted systemic inflammatory modulators show promise in preventing chronic kidney disease (CKD) progression, the causal link between specific inflammatory factors and CKD remains uncertain. Methods Using a genome-wide association study of 41 serum cytokines from 8,293 Finnish individuals, we conducted a bidirectional two-sample Mendelian randomization (MR) analysis. In addition, we genetically predicted causal associations between inflammatory factors and 5 phenotypes, including CKD, estimated glomerular filtration rate (eGFR), dialysis, rapid progression of CKD, and rapid decline in eGFR. Inverse variance weighting (IVW) served as the primary MR method, while MR-Egger, weighted median, and MR-pleiotropy residual sum and outlier (MR-PRESSO) were utilized for sensitivity analysis. Cochrane's Q test for heterogeneity. Leave-one-out method ensured stability of MR results, and Bonferroni correction assessed causal relationship strength. Results Seventeen cytokines were associated with diverse renal outcomes. Among them, after Bonferroni correction test, higher tumor necrosis factor alpha levels were associated with a rapid decrease in eGFR (OR = 1.064, 95% CI 1.028 - 1.103, P = 0.001), higher interleukin-4 levels were associated with an increase in eGFR (β = 0.003, 95% CI 0.001 - 0.005, P = 0.002), and higher growth regulated oncogene alpha (GROα) levels were associated with an increased risk of CKD (OR=1.035, 95% CI 1.012 - 1.058, P = 0.003). In contrast, genetic susceptibility to CKD was associated with an increase in GROa, and a decrease in eGFR may lead to an increase in stem cell factor. We did not find the presence of horizontal pleiotropy during the analysis. Conclusion We discovered causally related inflammatory factors that contribute to the initiation and progression of CKD at the genetic prediction level.
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Affiliation(s)
- Hongdian Li
- Department of Nephrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mingxuan Li
- Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Cong Liu
- Department of Nephrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Pengfei He
- Department of Nephrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ao Dong
- Department of Nephrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shaoning Dong
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Mianzhi Zhang
- Department of Nephrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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8
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Sangthawan P, Klyprayong P, Geater SL, Tanvejsilp P, Anutrakulchai S, Boongird S, Gojaseni P, Kuhiran C, Lorvinitnun P, Noppakun K, Parapiboon W, Sirilak S, Tankee P, Taruangsri P, Sangsupawanich P, Sritara P, Chaiyakunapruk N, Kitiyakara C. The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai "Peritoneal Dialysis First Policy". Front Public Health 2022; 10:965808. [PMID: 36311589 PMCID: PMC9606783 DOI: 10.3389/fpubh.2022.965808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Universal health coverage can decrease the magnitude of the individual patient's financial burden of chronic kidney disease (CKD), but the residual financial hardship from the patients' perspective has not been well-studied in low and middle-income countries (LMICs). This study aimed to evaluate the residual financial burden in patients with CKD stage 3 to dialysis in the "PD First Policy" under Universal Coverage Scheme (UCS) in Thailand. Methods This multicenter nationwide cross-sectional study in Thailand enrolled 1,224 patients with pre-dialysis CKD, hemodialysis (HD), and peritoneal dialysis (PD) covered by UCS and other health schemes for employees and civil servants. We interviewed patients to estimate the proportion with catastrophic health expenditure (CHE) and medical impoverishment. The risk factors associated with CHE were analyzed by multivariable logistic regression. Results Under UCS, the total out-of-pocket expenditure in HD was over two times higher than PD and nearly six times higher than CKD stages 3-4. HD suffered significantly more CHE and medical impoverishment than PD and pre-dialysis CKD [CHE: 8.5, 9.3, 19.5, 50.0% (p < 0.001) and medical impoverishment: 8.0, 3.1, 11.5, 31.6% (p < 0.001) for CKD Stages 3-4, Stage 5, PD, and HD, respectively]. In the poorest quintile of UCS, medical impoverishment was present in all HD and two-thirds of PD patients. Travel cost was the main driver of CHE in HD. In UCS, the adjusted risk of CHE increased in PD and HD (OR: 3.5 and 16.3, respectively) compared to CKD stage 3. Conclusions Despite universal coverage, the residual financial burden remained high in patients with kidney failure. CHE was considerably lower in PD than HD, although the rates remained alarmingly high in the poor. The "PD First' program" could serve as a model for other LMICs. However, strategies to minimize financial distress should be further developed, especially for the poor.
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Affiliation(s)
- Pornpen Sangthawan
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pinkaew Klyprayong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarayut L. Geater
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pimwara Tanvejsilp
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Sirirat Anutrakulchai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sarinya Boongird
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsathorn Gojaseni
- Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
| | - Charan Kuhiran
- Department of Medicine, Somdej Pranangchao Sirikit Hospital, Chonburi, Thailand
| | - Pichet Lorvinitnun
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Kajohnsak Noppakun
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watanyu Parapiboon
- Department of Medicine, Maharat Nakhonratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Supinda Sirilak
- Department of Internal Medicine, Naresuan University Hospital, Naresuan University, Phitsanulok, Thailand
| | - Pluemjit Tankee
- Department of Medicine, Vachiraphuket Hospital, Phuket, Thailand
| | | | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States,*Correspondence: Nathorn Chaiyakunapruk
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Chagriya Kitiyakara
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9
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Rizzolo K, Al-Rousan T, Cervantes L. Dialysis Decision Making and the Patient Experience: Lessons From Pakistan. Kidney Med 2022; 4:100556. [PMID: 36353649 PMCID: PMC9637990 DOI: 10.1016/j.xkme.2022.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katherine Rizzolo
- Department of Renal Medicine and Hypertension, University of Colorado, Aurora, CO
- Address for Correspondence: Katherine Rizzolo, MD, Department of Renal Medicine and Hypertension, University of Colorado, Aurora 80045, CO.
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, CA
| | - Lilia Cervantes
- Department of Medicine, University of Colorado Anschutz Campus, Aurora, CO
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10
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George C, Echouffo-Tcheugui JB, Jaar BG, Okpechi IG, Kengne AP. The need for screening, early diagnosis, and prediction of chronic kidney disease in people with diabetes in low- and middle-income countries-a review of the current literature. BMC Med 2022; 20:247. [PMID: 35915501 PMCID: PMC9344711 DOI: 10.1186/s12916-022-02438-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022] Open
Abstract
Chronic kidney disease (CKD) in people with diabetes is becoming an increasing major public health concern, disproportionately burdening low- and middle-income countries (LMICs). This rising burden is due to various factors, including the lack of disease awareness that results in late referral and the cost of screening and consequent treatment of the comorbid conditions, as well as other factors endemic to LMICs relating to inadequate management of risk factors. We critically assessed the extant literature, by performing searches of Medline via PubMed, EBSCOhost, Scopus, and Web of Science, for studies pertaining to screening, diagnosis, and prediction of CKD amongst adults with diabetes in LMICs, using relevant key terms. The relevant studies were summarized through key themes derived from the Wilson and Jungner criteria. We found that screening for CKD in people with diabetes is generally infrequent in LMICs. Also, LMICs are ill-equipped to appropriately manage diabetes-associated CKD, especially its late stages, in which supportive care and kidney replacement therapy (KRT) might be required. There are acceptable and relatively simple tools that can aid diabetes-associated CKD screening in these countries; however, these tools come with limitations. Thus, effective implementation of diabetes-associated CKD screening in LMICs remains a challenge, and the cost-effectiveness of such an undertaking largely remains to be explored. In conclusion, for many compelling reasons, screening for CKD in people with diabetes should be a high policy priority in LMICs, as the huge cost associated with higher mortality and morbidity in this group and the cost of KRT offers a compelling economic incentive for improving early detection of diabetes in CKD.
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Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Cape Town, South Africa.
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Diabetes Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Nephrology Center of Maryland, Baltimore, MD, USA
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.,Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Cape Town, South Africa
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11
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NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries. Lancet 2022; 399:1266-1278. [PMID: 35339227 PMCID: PMC8947779 DOI: 10.1016/s0140-6736(21)02347-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022]
Abstract
Most countries have made little progress in achieving the Sustainable Development Goal (SDG) target 3.4, which calls for a reduction in premature mortality from non-communicable diseases (NCDs) by a third from 2015 to 2030. In this Health Policy paper, we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income. Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4; country-level applications require additional analyses and consideration of the local implementation and utilisation context. Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions. We show how cost-effectiveness data and other information can be used to define locally tailored packages of interventions to accelerate rates of decline in NCD mortality. Under realistic implementation constraints, most countries could achieve (or almost achieve) the NCD target using a combination of these interventions; the greatest gains would be for cardiovascular disease mortality. Implementing the most efficient package of interventions in each world region would require, on average, an additional US$18 billion annually over 2023-30; this investment could avert 39 million deaths and generate an average net economic benefit of $2·7 trillion, or $390 per capita. Although specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks, such as tobacco smoking, harmful use of alcohol, and excess sodium intake, would be relevant in nearly every country, accounting for nearly two-thirds of the health gains of any locally tailored NCD package. By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Our report concludes with a discussion of financing and health system implementation considerations and reflections on the NCD agenda beyond the SDG target 3.4 and beyond the SDG period.
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12
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Pais P, Wightman A. Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance. Front Pediatr 2022; 10:842783. [PMID: 35359883 PMCID: PMC8963107 DOI: 10.3389/fped.2022.842783] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/10/2022] [Indexed: 01/10/2023] Open
Abstract
Children with kidney failure require kidney replacement therapy (KRT), namely maintenance dialysis and kidney transplant. Adequate kidney failure care consists of KRT or conservative treatment with palliative care. In the context of kidney failure, children depend on parents who are their surrogate decision-makers, and the pediatric nephrology team for taking decisions about KRT or conservative care. In this paper, we discuss the ethical challenges that arise relating to such decision-making, from a global perspective, using the framework of pediatric bioethics. While many ethical dilemmas in the care of children with KRT are universal, the most significant ethical dilemma is the inequitable access to KRT in low & middle income countries (LMICs) where rates of morbidity and mortality depend on the family's ability to pay. Children with kidney failure in LMICs have inadequate access to maintenance dialysis, timely kidney transplant and palliative care compared to their counterparts in high income countries. Using case vignettes, we highlight how these disparities place severe burdens on caregivers, resulting in difficult decision-making, and lead to moral distress among pediatric nephrologists. We conclude with key action points to change this status-quo, the most important being advocacy by the global pediatric nephrology community for better access to affordable kidney failure care for children.
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Affiliation(s)
- Priya Pais
- Department of Pediatric Nephrology, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Aaron Wightman
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, United States
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13
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Iyengar A, McCulloch MI. Paediatric kidney transplantation in under-resourced regions-a panoramic view. Pediatr Nephrol 2022; 37:745-755. [PMID: 33837847 PMCID: PMC8035609 DOI: 10.1007/s00467-021-05070-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/21/2020] [Accepted: 03/24/2021] [Indexed: 01/10/2023]
Abstract
Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.
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Affiliation(s)
- Arpana Iyengar
- Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India.
| | - M I McCulloch
- Pediatric Nephrology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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14
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Tonelli M, Tiv S, Anand S, Mohan D, Garcia Garcia G, Gutiérrez Padilla JA, Klarenbach S, Navarro Blackaller G, Seck S, Wang J, Zhang L, Muntner P. Diagnostic Yield of Population-Based Screening for Chronic Kidney Disease in Low-Income, Middle-Income, and High-Income Countries. JAMA Netw Open 2021; 4:e2127396. [PMID: 34605917 PMCID: PMC8491102 DOI: 10.1001/jamanetworkopen.2021.27396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Population-based screening for chronic kidney disease (CKD) is sometimes recommended based on the assumption that detecting CKD is associated with beneficial changes in treatment. However, the treatment of CKD is often similar to the treatment of hypertension or diabetes, which commonly coexist with CKD. OBJECTIVE To determine the frequency with which population-based screening for CKD is associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data obtained from studies that evaluated CKD in population-based samples from China (2007-2010), India (2010-2014), Mexico (2007-2008), Senegal (2012), and the United States (2009-2014), including a total of 126 242 adults screened for CKD. Data were analyzed from January 2020 to March 2021. MAIN OUTCOMES AND MEASURES The primary definition of CKD was estimated glomerular filtration rate less than 60 mL/min/1.73 m2. For individuals with CKD, the need for a treatment change was defined as not taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker or having blood pressure levels of 140/90 mm Hg or greater. For individuals with CKD who also had diabetes, the need for a treatment change was also defined as having hemoglobin A1c levels of 8% or greater or fasting glucose levels of 178.4 mg/dL (9.9 mmol/L) or greater. Case finding was defined as testing for CKD only in adults with hypertension or diabetes. RESULTS Among 126 242 adults screened for CKD, there were 47 204 patients in the China cohort, 9817 patients in the India cohort, 51 137 patients in the Mexico cohort, 2441 patients in the Senegal cohort, and 15 643 patients in the US cohort. The mean age of participants was 49.6 years (95% CI, 49.5-49.7 years) in the China cohort, 42.9 years (95% CI, 42.6-43.2 years) in the India cohort, 51.6 years (95% CI, 51.5-51.7 years) in the Mexico cohort, 48.2 years (95% CI, 47.5-48.9 years) in the Senegal cohort, and 47.3 years (95% CI, 46.6-48.0 years) in the US cohort. The proportion of women was 57.3% (95% CI, 56.9%-57.7%) in the China cohort, 53.4% (95% CI, 52.4%-54.4%) in the India cohort, 68.8% (95% CI, 68.4%-69.2%) in the Mexico cohort, 56.0% (95% CI, 54.0%-58.0%) in the Senegal cohort, and 51.9% (51.0%-52.7%) in the US cohort. The prevalence of CKD was 2.5% (95% CI, 2.4%-2.7%) in the China cohort, 2.3% (95% CI, 2.0%-2.6%) in the India cohort, 10.6% (95% CI, 10.3%-10.9%) in the Mexico cohort, 13.1% (95% CI, 11.7%-14.4%) in the Senegal cohort, and 6.8% (95% CI, 6.2%-7.5%) in the US cohort. Screening for CKD was associated with the identification of additional adults whose treatment would change (beyond those identified by measuring blood pressure and glycemia) per 1000 adults: China: 8 adults (95% CI, 8-9 adults); India: 5 adults (95% CI, 4-7 adults); Mexico: 26 adults (95% CI, 24-27 adults); Senegal: 59 adults (95% CI, 50-69 adults); and the US: 19 adults (95% CI, 16-23 adults). Case finding was associated with the identification of 46.2% (95% CI, 45.1%-47.4%) to 86.4% (95% CI, 85.4%-87.3%) of individuals with CKD depending on the country, an increase in the proportion of individuals requiring a treatment change by as much 89.6% (95% CI, 80.4%-99.3%) in the US, and a decrease in the proportion of individuals needing GFR measurements by as much as 57.8% (95% CI, 56.3%-59.3%) in the US. CONCLUSIONS AND RELEVANCE This study found that most additional individuals with CKD identified by population-based screening programs did not need a change in treatment compared with a strategy of measuring blood pressure and assessing glycemia and that case finding was more efficient than screening for early detection of CKD.
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Affiliation(s)
| | - Sophanny Tiv
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Guillermo Garcia Garcia
- Hospital Civil de Guadalajara Fray Antonio Alcalde, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - José Alfonso Gutiérrez Padilla
- Hospital Civil de Guadalajara Fray Antonio Alcalde, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Guillermo Navarro Blackaller
- Hospital Civil de Guadalajara Fray Antonio Alcalde, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Sidy Seck
- Department of Internal Medicine and Nephrology, Gaston Berger University, Saint-Louis, Senegal
| | - Jinwei Wang
- Peking University Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Luxia Zhang
- Peking University Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama, Tuscaloosa
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15
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Heaf J, Heiro M, Petersons A, Vernere B, Povlsen JV, Sørensen AB, Clyne N, Bumblyte I, Zilinskiene A, Randers E, Løkkegaard N, Ots-Rosenberg M, Kjellevold S, Kampmann JD, Rogland B, Lagreid I, Heimburger O, Lindholm B. Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study. Clin Kidney J 2021; 14:2064-2074. [PMID: 34476093 PMCID: PMC8406075 DOI: 10.1093/ckj/sfaa260] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background In patients with end-stage kidney disease (ESKD), home dialysis offers socio-economic and health benefits compared with in-centre dialysis but is generally underutilized. We hypothesized that the pre-dialysis course and institutional factors affect the choice of dialysis modality after dialysis initiation (DI). Methods The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of the choice of dialysis modality were registered. Results Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications [384 ( 24.2%)] or no assessment [106 (6.7%); mainly due to late referral and/or suboptimal DI] or death [26 (1.6%)]. Older age, comorbidity, late referral, suboptimal DI, acute illness and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (HD; 3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to the choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a ‘home dialysis first’ institutional policy. Conclusions Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reduce the incidence of late referral and unplanned DI and, in acutely ill patients, by implementing an educational programme after improvement of their clinical condition.
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Affiliation(s)
- James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maija Heiro
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - Aivars Petersons
- Latvia Nephrology Department, P. Stradins University Hospital, Riga, Latvia
| | - Baiba Vernere
- Latvia Nephrology Department, P. Stradins University Hospital, Riga, Latvia
| | - Johan V Povlsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Naomi Clyne
- Department of Nephrology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Inge Bumblyte
- Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alanta Zilinskiene
- Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Else Randers
- Department of Medicine, Viborg Regional Hospital, Viborg, Denmark
| | | | - Mai Ots-Rosenberg
- Department of Nephrology, University Hospital of Tartu, Tartu, Estonia
| | | | | | - Björn Rogland
- Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden
| | - Inger Lagreid
- Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Olof Heimburger
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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16
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Shekhani SS, Lanewala AA. Ethical Challenges in Dialysis and Transplantation: Perspectives From the Developing World. Semin Nephrol 2021; 41:211-219. [PMID: 34330361 DOI: 10.1016/j.semnephrol.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Renal replacement therapies including dialysis and transplantation for patients with end-stage kidney failure are treatment options beyond the reach of a large segment of the population, particularly in resource-constrained settings. Health care professionals practicing within developing countries face unique ethical issues in the provision of these treatment options despite the existence of free treatment at different centers. Apart from issues of accessibility of dialysis services, initiation of treatment can have disastrous consequences for the entire family unit, which is magnified in collectivist societies. Several cost-cutting measures also may have to be used that raise moral dilemmas for physicians. Although transplantation is considered the most cost-effective solution in developing countries, leading to significantly better quality of life, issues of consent from biologically related living donors and the use of marginal donors may place physicians in a quandary. Policy making in developing countries must consider the socioeconomic implications of treatment choices that extend far beyond the treatment cost.
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Affiliation(s)
- Sualeha Siddiq Shekhani
- Center of Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ali Asghar Lanewala
- Department of Pediatric Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
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17
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Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, Nee R. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol 2021; 52:98-107. [PMID: 33752206 PMCID: PMC8057343 DOI: 10.1159/000514550] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The global epidemiology of end-stage kidney disease (ESKD) reflects each nation's unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs). SUMMARY From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. Key Messages: Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.
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Affiliation(s)
- John S Thurlow
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Megha Joshi
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Lawrence Y Agodoa
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina M Yuan
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA,
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18
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Abstract
Public policy for kidney replacement therapy eludes most low- and middle-income countries owing to the seemingly low number of cases and high cost. Countries such as Thailand have shown that public health authorities can effectively provide treatment and elevate health care for populations by overcoming some common challenges.
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19
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Luyckx VA, Al-Aly Z, Bello AK, Bellorin-Font E, Carlini RG, Fabian J, Garcia-Garcia G, Iyengar A, Sekkarie M, van Biesen W, Ulasi I, Yeates K, Stanifer J. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 2020; 17:15-32. [PMID: 33188362 PMCID: PMC7662029 DOI: 10.1038/s41581-020-00363-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress. Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease. Each Sustainable Development Goal (SDG) has the potential to improve kidney health and prevent kidney disease by improving the general health and well-being of individuals and societies, and by protecting the environment. Achievement of each SDG is interrelated to the achievement of multiple other SDGs; therefore, a multisectoral approach is required. The global burden of kidney disease has been relatively underestimated because of a lack of data. Structural violence and the social determinants of health have an important impact on kidney disease risk. Kidney disease is the leading global cause of catastrophic health expenditure, in part because of the high costs of kidney replacement therapy. Achievement of universal health coverage is the minimum requirement to ensure sustainable and affordable access to early detection and quality treatment of kidney disease and/or its risk factors, which should translate to a reduction in the burden of kidney failure in the future.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. .,Institute of Biomedical Ethics and the History of Medicine, University of Zürich, Zürich, Switzerland.
| | - Ziyad Al-Aly
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA.,Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO, USA
| | - Aminu K Bello
- Division of Nephrology & Immunology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Raul G Carlini
- Sección de Investigación, Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital, 278, Guadalajara, Mexico
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Stanifer
- Munson Nephrology, Munson Healthcare, Traverse City, MI, USA
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20
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Bello AK, Brown M, Caskey FJ, Donner JA, Liew A, Muller E, Naicker S, O'Connell PJ, Filho RP, Vachharajani T. Strategic plan for integrated care of patients with kidney failure. Kidney Int 2020; 98:S117-S134. [PMID: 33126957 DOI: 10.1016/j.kint.2020.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, University of New South Wales (UNSW), New Delhi, India; Manipal Academy of Higher Education (MAHE), Manipal, Kamataka, India
| | - Aminu K Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Brown
- Department of Renal Medicine, St. George Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Saraladevi Naicker
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Tushar Vachharajani
- Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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21
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Abstract
Dialysis adequacy is conventionally quantified as net urea clearance. Single pool (sp) Kt/Vurea remains the best studied measure of dialysis adequacy globally. Other measures such as fluid status control, anemia correction, and mineral metabolism are monitored variably. Increasing use of hemodiafiltration across Europe and many parts of Japan and Australia is predicated on studies showing better patient survival with middle molecule clearance. Apart from local clinical practice guidelines, the income level and public health policy of a country determine quality of dialysis services. Among developed nations, small solute clearance adequacy targets are achieved with high frequency. In the United States, dialysis adequacy target is met by focussing on high blood flow rates and large dialyzer size, sometimes at the cost of session time. In Japan, Australia, and Germany, session length is given importance. Dialysis adequacy reporting is restricted and inconsistent in developing nations. The Gulf Cooperation Council countries, Russia and Malaysia, respectively, are close to achieving dialysis adequacy target (spKt/Vurea ≥1.2) universally in their dialysis populations. Patient-reported outcomes are typically measured only in developed countries. Patient survival on dialysis, partly linked to dialysis adequacy, varies greatly around the world, with Japan having the best survival rates. Until the development of better markers of dialysis adequacy, universal consistency in reporting of conventional parameters with a focus on patient-reported measures should be endeavored.
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Affiliation(s)
- Joyita Bharati
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
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22
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Tonelli M, Dickinson JA. Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries. J Am Soc Nephrol 2020; 31:1931-1940. [PMID: 32839279 PMCID: PMC7461685 DOI: 10.1681/asn.2020030277] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CKD is common, costly, and associated with adverse health outcomes. Because inexpensive treatments can slow the rate of kidney function loss, and because CKD is asymptomatic until its later stages, the idea of early detection of CKD to improve outcomes ignites enthusiasm, especially in low- and middle-income countries where renal replacement is often unavailable or unaffordable. Available data and prior experience suggest that the benefits of population-based screening for CKD are uncertain; that there is potential for harms; that screening is not a wise use of resources, even in high-income countries; and that screening has substantial opportunity costs in low- and middle-income countries that offset its hypothesized benefits. In contrast, some of the factors that diminish the value of population-based screening (such as markedly higher prevalence of CKD in people with diabetes, hypertension, and cardiovascular disease, as well as high preexisting use of kidney testing in such patients) substantially increase the appeal of searching for CKD in people with known kidney risk factors (case finding) in high-income countries as well as in low- and middle-income countries. For both screening and case finding, detection of new cases is the easiest component; the real challenge is ensuring appropriate management for a chronic disease, usually for years or even decades. This review compares and contrasts the benefits, harms, and opportunity costs associated with these two approaches to early detection of CKD. We also suggest criteria (discussed separately for high-income countries and for low- and middle-income countries) to use in assessing when countries should consider case finding versus when they should consider foregoing systematic attempts at early detection and focus on management of known cases.
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Affiliation(s)
- Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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23
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Harris DC, Davies SJ, Finkelstein FO, Jha V. The second Global Kidney Health Summit outputs: developing a strategic plan to increase access to integrated end-stage kidney disease care worldwide. Kidney Int Suppl (2011) 2020; 10:e1-e2. [PMID: 32154795 PMCID: PMC7031682 DOI: 10.1016/j.kisu.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- David C.H. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Simon J. Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Manipal Academy of Higher Education (MAHE), Manipal, India
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