Fulltext

Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia

Alexander S 1 , Jasuja S 2 , Gallieni M 3 , Sahay M 4 , Rana DS 5 , Jha V 6 Show all authors , Verma S 7 , Ramachandran R 8 , Bhargava V 5 , Sagar G 2 , Bahl A 2 , Mostafi M 9 , Pisharam JK 10 , Tang SCW 11 , Jacob C 12 , Gunawan A 13 , Leong GB 14 , Thwin KT 15 , Agrawal RK 16 , Vareesangthip K 17 , Tanchanco R 18 , Choong LHL 19 , Herath C 20 , Lin CC 21 , Cuong NT 22 , Haian HP 23 , Akhtar SF 24 , Alsahow A 25 , Rajapurkar MM 26 , Kher V 27 , Mehta H 28 , Bhalla AK 5 , Khanna UB 29 , Ray DS 30 , Puri S 31 , Jain H 7 , Lydia A 32 , Vachharajani T 33

Affiliations 

  • 1 Department of Nephrology, Christian Medical College, Vellore 632004, India
  • 2 Department of Nephrology, Indraprastha Apollo Hospital, Delhi 110020, India
  • 3 Department of Nephrology, "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milano, Milan 20157, Italy
  • 4 Department of Nephrology, Osmania General Hospital, Hyderabad 500012, India
  • 5 Department of Nephrology, Sir Gangaram Hospital, Delhi 110060, India
  • 6 Department of Nephrology, George Institute of Global Health, Delhi 110025, India
  • 7 Clinical Research, AVATAR Foundation, New Delhi 110025, India
  • 8 Department of Nephrology, PGIMER, Chandigarh 160012, India
  • 9 Department of Nephrology, Armed Forces Medical College, Dhaka Cantonment, Dhaka 1206, Bangladesh
  • 10 Department of Nephrology, Ministry of Health, Brunei Darussalam Medical Services, BB3910, Brunei Darussalam
  • 11 Department of Nephrology, Queen Mary Hospital, Pok Fu Lam Road DD3LM 1969, Pok Fu Lam, Hong Kong
  • 12 Department of Nephrology, Bangalore Baptist Hospital, Bengaluru 560024, India
  • 13 Department of Nephrology, Brawijaya University, Malang 65145, Indonesia
  • 14 Department of Nephrology, Serdang Hospital, Selangor 43000, Malaysia
  • 15 Department of Nephrology, University of Medicine, North Okkalapa 11031, Yangon, Myanmar
  • 16 Department of Nephrology, Bir Hospital, Kathmandu 44600, Nepal
  • 17 Department of Nephrology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • 18 Department of Nephrology, The Medical City, Pasig City 1605, Philippines
  • 19 Department of Nephrology, Singapore General Hospital 169608, Singapore
  • 20 Department of Nephrology, Sri Jayewardenepura General Hospital, Nugegoda 10100, Sri Lanka
  • 21 Department of Nephrology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan
  • 22 Department of Kidney Disease and Dialysis, Vietduc University Hospital, No 40, Trangathi Street, Hanoi, Vietnam
  • 23 Department of Nephrology, Viet Duc University Hospital, Hanoi 40, Vietnam
  • 24 Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Pakistan
  • 25 Department of Nephrology, Jahra Hospital, Al Jahra, Kuwait
  • 26 Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad 387001, India
  • 27 Department of Nephrology, Medanta Hospital, Gurugram 122006, India
  • 28 Department of Nephrology, Lilawati Hospital, Mumbai 400050, India
  • 29 Department of Nephrology, Lancelot Kidney & GI Centre in Borivali West, Mumbai 400092, India
  • 30 Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata 700026, India
  • 31 Department of Nephrology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
  • 32 Department of Nephrology and Hypertension, Universitas Indonesia-Dr Cipto Mangunkusumo Hospital, Salemba 10430, Jakarta, Indonesia
  • 33 Department of Nephrology, Cleveland Clinic, Cleveland, OH 44195, USA
Int J Nephrol, 2021;2021:6665901.
PMID: 34035962 DOI: 10.1155/2021/6665901

Abstract

Background: The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA).

Methods: Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care.

Results: Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). "On-demand" hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%-20% in the majority of LE countries.

Conclusion: Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications