Achieving global equity in treating kidney disease
Worldwide, approximately 1.4 million people, with severe (end-stage) kidney disease, rely on continuing dialysis or a kidney transplant to survive. High rates of kidney disease affect low, middle and high-income countries alike. However, in low and middle-income countries, the costs and infrastructure involved in providing dialysis and transplant services mean that, for most sufferers, treatment options are seriously inadequate.
A number of strategies could make life-saving dialysis and transplantation available to many more people in need:
- development of locally appropriate transplantation and organ donor programs
- effectively coordinated use of public, non-governmental and private sources of funding
- service planning and cost containment
- use of generic drugs and local manufacture of dialysis consumables
- technical, educational and financial support from the international kidney disease and transplant community.
Associate Professor Alan Cass, Director of the Renal Division at The George Institute and Associate Professor of Renal Health, University of Sydney explains, "A number of middle-income countries have shown that more equitable provision of dialysis and transplantation is possible. In Malaysia, dialysis services are provided through a mix of public hospitals, private, non-government and non-profit centres. In Costa Rica, transplantation, which is the most cost-effective form of treatment, is a high priority in resource allocation."
Ms Sarah White, Research Fellow in the Renal Division and PhD student, Central Clinical School, University of Sydney, says approximately 80% of the world’s dialysis and transplant patients live in Europe, Japan or North America. "In India, by contrast, at least 90% of people with end-stage kidney disease die without any treatment."
"Low and middle-income countries have limited capacity to fund treatment. In China, dialysis costs around US$7,500 per patient per year, and in India US$5,000. This poses major challenges for affected individuals or for their governments. Budget constraints and lack of trained personnel mean that therapies are rationed and, in most cases, a user-pays system is relied upon.
"Diabetes is now the leading cause of end-stage kidney disease in many countries. The global epidemic of type 2 diabetes, coupled with an ageing population, will increase the prevalence of end-stage kidney disease, particularly in developing regions.
"The actual global burden of end-stage kidney disease is hidden behind statistics which reflect only the number of people treated, not those who die without having received treatment. This is particularly true for low-income countries," said Associate Professor Cass.
"To achieve greater equity in access to dialysis and transplantation for people in low-and middle-income countries, education, policy development and ongoing support from international professional bodies, government and non-government organisations are essential. Prevention, ideally an integrated approach to heart disease, stroke, diabetes and kidney disease, must also be a key objective," he said.
The full report, How can we achieve global equity in provision of renal replacement therapy? by the Renal Division at The George Institute, in collaboration with the Central and Western Clinical Schools of the University of Sydney, was published in the March edition of the Bulletin of the World Health Organisation.