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Gadelkareem RA, Abdelgawad AM, Mohammed N, Zarzour MA, Khalil M, Reda A, Hammouda HM. Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies? World J Methodol 2024; 14:91626. [PMID: 38983660 PMCID: PMC11229866 DOI: 10.5662/wjm.v14.i2.91626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 06/13/2024] Open
Abstract
Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Amr Mostafa Abdelgawad
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nasreldin Mohammed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohammed Ali Zarzour
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Khalil
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Reda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hisham Mokhtar Hammouda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Padayachee S, Adam A, Fabian J. The impact of diabetes and hypertension on renal allograft survival- A single center study. Curr Urol 2023; 17:286-291. [PMID: 37994332 PMCID: PMC10662914 DOI: 10.1097/cu9.0000000000000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background To determine the impact of pre-transplant diabetes mellitus (DM) and post-transplant hypertension (HT) at 1 year on renal allograft survival in all adult first kidney-only (FKO) transplant recipients at a single transplant center in Johannesburg, South Africa. Materials and methods A retrospective review was conducted of all adult FKO transplant procedures at the Charlotte Maxeke Johannesburg Academic Hospital transplant unit between 1966 and 2013. Results During the stipulated timeframe, 1685 adult FKO transplant procedures were performed. Of these, 84.1% were from deceased donors (n = 1413/1685). The prevalence of pre-transplant DM transplant recipients with no missing or incomplete records was 6.5% (n = 107/1625). Of the total cohort of 1685 adult FKO transplant recipients, 63.6% of those with no missing data survived to 1 year (n = 1072/1685). The prevalence of HT at 1-year post-transplant was 53.6% (n = 503/1072). HT at 1-year post-transplant, even after adjusted survival analysis, proved a significant risk factor for renal allograft loss (hazard ratio, 1.63; 95% confidence interval, 1.37-1.94) (p < 0.0001). Similarly, after adjusted survival analysis, the risk of renal allograft loss within the pre-transplant DM group was significantly higher (p = 0.043; hazard ratio, 1.26; 95% confidence interval, 1.01-1.58). Conclusions This study identified pre-transplantation diabetes mellitus and post-transplantation HT as significant risk factors for graft loss within the population assessed in this region of the world. These factors could potentially be used as independent predictors of renal graft survival.
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Affiliation(s)
- Sumesh Padayachee
- Division of Urology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Adam
- Division of Urology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Urology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Helen Joseph Hospital (HJH), and Rahima; Moosa Mother & Child Hospital (RMMCh); Wits Donald Gordon Medical Center, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Center, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mtingi-Nkonzombi L, Manning K, Du Toit T, Muller E, Redd AD, Freercks R. The state of kidney replacement therapy in Eastern Cape Province, South Africa: A call to action. S Afr Med J 2023. [DOI: 10.7196/samj.2023.v113i4.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Background. South Africa (SA) is one of the most financially unequal countries in the world. This situation is highlighted by disparateaccess to healthcare, particularly provision of kidney replacement therapy (KRT). Unlike the private sector, public sector access to KRT is highly rationed, and patient selection is based on suitability for transplantation and capacity.Objectives. To investigate the state of the KRT service in Eastern Cape Province, SA, by analysing access to and provision of KRT in theprovince for individuals with end-stage kidney disease, as well as disparities between the private and public healthcare systems.Methods. This was a retrospective descriptive study to examine KRT provision and temporal trends in the Eastern Cape. Data were obtained from the South African Renal Registry and the National Transplant Waiting List. KRT provision was compared between the three main referral centres, in Gqeberha (formerly Port Elizabeth), East London and Mthatha, and between the private and public healthcare systems.Results. There were 978 patients receiving KRT in the Eastern Cape, with an overall treatment rate of 146 per million population (pmp).The treatment rate for the private sector was 1 435 pmp, compared with 49 pmp in the public sector. Patients treated in the private sector were older at initiation of KRT (52 v. 34 years), and more likely to be male, to be HIV positive, and to receive haemodialysis as their KRT modality. Peritoneal dialysis was more commonly used in Gqeberha and East London as the first and subsequent KRT modality, compared with Mthatha. There were no patients from Mthatha on the transplant waiting list. There were no waitlisted HIV-positive patients in the public sector in East London, compared with 16% of the public sector patients in Gqeberha. The kidney transplant prevalence rate was 58 pmp in the private sector and 19 pmp in the public sector, with a combined prevalence of 22 pmp, constituting 14.9% of all patients on KRT. We estimated the shortfall of KRT provision in the public sector to be ~8 606 patients.Conclusion. Patients in the private sector were 29 times more likely to access KRT than their public sector counterparts, who were onaverage 18 years younger at initiation of KRT, probably reflecting selection bias in an overburdened public health system. Transplantation rates were low in both sectors, and lowest in Mthatha. A large public sector KRT provision gap exists in the Eastern Cape and needs to be addressed urgently.
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Mudiayi D, Shojai S, Okpechi I, Christie EA, Wen K, Kamaleldin M, Elsadig Osman M, Lunney M, Prasad B, Osman MA, Ye F, Khan M, Htay H, Caskey F, Jindal KK, Klarenback S, Jha V, Rondeau E, Turan Kazancioglu R, Ossareh S, Jager KJ, Kovesdy CP, O’Connell PJ, Muller E, Olanrewaju T, Gill JS, Tonelli M, Harris DC, Levin A, Johnson DW, Bello AK. Global Estimates of Capacity for Kidney Transplantation in World Countries and Regions. Transplantation 2022; 106:1113-1122. [PMID: 34495014 PMCID: PMC9128615 DOI: 10.1097/tp.0000000000003943] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kidney transplantation (KT) is the optimal treatment for kidney failure and is associated with better quality of life and survival relative to dialysis. However, knowledge of the current capacity of countries to deliver KT is limited. This study reports on findings from the 2018 International Society of Nephrology Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of KT across countries and regions. METHODS Data were collected from published online sources, and a survey was administered online to key stakeholders. All country-level data were analyzed by International Society of Nephrology region and World Bank income classification. RESULTS Data were collected via a survey in 182 countries, of which 155 answered questions pertaining to KT. Of these, 74% stated that KT was available, with a median incidence of 14 per million population (range: 0.04-70) and median prevalence of 255 per million population (range: 3-693). Accessibility of KT varied widely; even within high-income countries, it was disproportionately lower for ethnic minorities. Universal health coverage of all KT treatment costs was available in 31%, and 57% had a KT registry. CONCLUSIONS There are substantial variations in KT incidence, prevalence, availability, accessibility, and quality worldwide, with the lowest rates evident in low- and lower-middle income countries. Understanding these disparities will inform efforts to increase awareness and the adoption of practices that will ensure high-quality KT care is provided around the world.
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Affiliation(s)
- Dominic Mudiayi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Emily A. Christie
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kevin Wen
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mostafa Kamaleldin
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohamed Elsadig Osman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, SK, Canada
| | - Mohamed A. Osman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maryam Khan
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Fergus Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Kailash K. Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Scott Klarenback
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College London, London, United Kingdom
- Department of Medicine, Manipal Academy of Higher Education, Manipal, India
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculty of Medicine, Sorbonne Université, Paris, France
| | | | - Shahrzad Ossareh
- Section of Nephrology and Hemodialysis, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kitty J. Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Csaba P. Kovesdy
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Philip J. O’Connell
- Renal Unit, Westmead Clinical School, University of Sydney at Westmead Hospital, Sydney, NSW, Australia
- The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Elmi Muller
- Division of General Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | | | - John S. Gill
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
| | - David C. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David W. Johnson
- Department of Nephrology, Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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