Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia (original) (raw)
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Dialysis Care and Dialysis Funding in Asia
American Journal of Kidney Diseases, 2019
Asia is the largest and most populated continent in the world, with a high burden of kidney failure. In this Policy Forum article, we explore dialysis care and dialysis funding in 17 countries in Asia, describing conditions in both developed and developing nations across the region. In 13 of the 17 countries surveyed, diabetes is the most common cause of kidney failure. Due to great variation in gross domestic product per capita across Asian countries, disparities in the provision of kidney replacement therapy (KRT) exist both within and between countries. A number of Asian nations have satisfactory access to KRT and have comprehensive KRT registries to help inform practices, but some do not, particularly among low-and low-to-middle-income countries. Given these differences, we describe the economic status, burden of kidney failure, and cost of KRT across the different modalities to both governments and patients and how changes in health policy over time affect outcomes. Emerging trends suggest that more affluent nations and those with universal health care or access to insurance have much higher prevalent dialysis and transplantation rates, while in less affluent nations, dialysis access may be limited and when available, provided less frequently than optimal. These trends are also reflected by an association between nephrologist prevalence and individual nations' incomes and a disparity in the number of nephrologists per million population and per thousand KRT patients. A sia is inhabited by some 4.4 billion people, constituting 60% of the world's population spread over 50 countries. Asia is commonly divided into 5 regions: Central Asia,
Current status of chronic kidney disease care in southeast Asia.
Chronic kidney disease (CKD) is a major health problem for the underdeveloped countries of southeast Asia, home to more than 2 billion people. The true incidence and prevalence in the region is not known, but estimates suggest that the prevalence may be more than that reported in Western societies. The majority of affected individuals are young and in the most productive years of their lives. The looming epidemic of diabetes and hypertension is likely to further add to the disease burden. A high prevalence has been reported from some regions, suggesting the presence of unique etiologic factors. A large proportion of patients present late, with advanced kidney failure and multiple complications. Management is hampered by the lack of health care services, especially in the rural areas. The health care expenditure by the governments in these countries is very low, and there are no regional or national policies for chronic disease management including CKD. There is a major shortage of trained nephrologists. In absence of any government or private reimbursement, most patients cannot afford the high treatment cost. Renal replacement therapy is available only to a minority. The practice of dialysis in the region is not standardized and a large number of patients develop complications. There is an urgent need to develop CKD detection and prevention programs. Investigations are required to characterize the unique etiologic factors in different geographic regions so that prevention programs can be targeted appropriately. Cost-cutting strategies would make renal replacement therapy accessible to the general population. According sufficient prominence to CKD in education programs would help increase awareness.
Chronic kidney disease hotspots in developing countries in South Asia
Clinical Kidney Journal, 2015
In many developing countries in the South Asian region, screening for chronic diseases in the community has shown a widely varying prevalence. However, certain geographical regions have shown a high prevalence of chronic kidney disease (CKD) of unknown etiology. This predominantly affects the young and middle-aged population with a lower socioeconomic status. Here, we describe the hotspots of CKD of undiagnosed etiology in South Asian countries including the North, Central and Eastern provinces of Sri Lanka and the coastal region of the state of Andhra Pradesh in India. Screening of these populations has revealed cases of CKD in various stages. Race has also been shown to be a factor, with a much lower prevalence of CKD in whites compared to Asians, which could be related to the known influence of ethnicity on CKD development as well as environmental factors. The difference between developed and developing nations is most stark in the realm of healthcare, which translates into CKD hotspots in many regions of South Asian countries. Additionally, the burden of CKD stage G5 remains unknown due to the lack of registry reports, poor access to healthcare and lack of an organized chronic disease management program. The population receiving various forms of renal replacement therapy has dramatically increased in the last decade due to better access to point of care, despite the disproportionate increase in nephrology manpower. In this article we will discuss the nephrology care provided in various countries in
Kidney International Supplements, 2021
Kidney failure is the permanent impairment of kidney function associated with increased morbidity, hospitalization, and requirement for kidney replacement therapy. A total of 11 countries in the Middle East region (84.6%) responded to the survey. The prevalence of chronic kidney disease in the region ranged from 5.2% to 10.6%, whereas prevalence of treated kidney failure ranged from 152 to 826 per million population. Overall, the incidence of kidney transplantation was highest in Iran (30.9 per million population) and lowest in Oman and the United Arab Emirates (2.2 and 3.0 per million population, respectively). Long-term hemodialysis services were available in all countries, long-term peritoneal dialysis services were available in 9 (69.2%) countries, and transplantation services were available in most countries of the region. Public funding covered the costs of nondialysis chronic kidney disease care in two-thirds of countries, and kidney replacement therapy in nearly all countries. More than half of the countries had dialysis registries; however, national noncommunicable disease strategies were lacking in most countries. The Middle East is a region with high burden of kidney disease and needs cost-effective measures through effective health care funding to be available to improve kidney care in the region. Furthermore, well-designed and sustainable health information systems are needed in the region to address current gaps in kidney care in the region.
Global Kidney Health Atlas: a spotlight on the Asia-Pacific sector
Kidney Research and Clinical Practice, 2022
Chronic kidney disease (CKD) is a unique public health problem in terms of high expenses required for its management and its increasing worldwide incidence. Understanding the existing structure of CKD treatment and its epidemiology is pivotal for equitable kidney care globally. The Global Kidney Health Atlas (GKHA) was launched by the International Society of Nephrology (ISN) in 2017 as a part of its “Bridging the Gaps” strategy with a vision to understand the global kidney care capacity. Two rounds of GKHA surveys were conducted and published in 2017 and 2019, respectively. The GKHA surveys showed significant variability in kidney care among global regions. Asia is the largest of all continents and distinct for its heterogeneity. The Asia-Pacific sector comprises four main regional constructs of the ISN; North and East Asia, Oceania and South East Asia, South Asia, and the Middle East. Kidney care capacity varies among these regions in terms of government spending, epidemiology of ...
Frontiers in Nephrology
The social determinants of health (SDoH) are the non-medical factors that influence kidney health outcomes directly or indirectly in a substantial manner and include conditions in which people are born, grow, work, live, and age. Many such challenges in lower- and middle- income countries have an unfavourable impact on kidney health. These conditions potentially influence economic policies and systems, development agendas, social norms, social policies, and political systems. In addition, many political and legal factors also determine and modify the ultimate outcome in patients with kidney disease. Legal factors that ensure universal health care, promote gender and racial equality, prevent malpractices and regulate strict laws in the field of kidney transplantation are the paramount determinants for the provision of necessary kidney care. Converging lines of evidence have supported the impact of social variables such as socioeconomic resources, social inclusion, housing conditions,...