The South East Asian region (SEAR) and South Asian countries (SACs) are divided as high and high-middle economies (HEs), low and lower-middle economies (LEs), and countries not classified due to lack of data (1) (Figure 1). The association between kidney disease and economic status is complex and directly affects therapeutic management. A rising burden of hypertension and diabetes mellitus in the region, with a high prevalence of smoking (11.8% in India), leads to the inter-related comorbidities for cardiovascular diseases and chronic kidney disease (CKD).
South Asia and Southeast Asia regional depiction based on economy
Citation: Kidney News 13, 12
South Asia and Southeast Asia regional depiction based on economy
Citation: Kidney News 13, 12
South Asia and Southeast Asia regional depiction based on economy
Citation: Kidney News 13, 12
The overall higher morbidity and mortality of end stage kidney disease (ESKD) patients are due to poor availability of medical insurance, lack of government funding, limited means for out-of-pocket payment coupled with illiteracy, lack of awareness of dialysis, limited deceased donor transplant acceptance, and administrative delays (2). Moreover, patients are afraid of any type of dialysis, and it prompts them to use alternative medicines. Also, due to prevailing myths about dialysis—could cause death, expensive, inability to work, burden on family, etc.—patients try to avoid it. Furthermore, there is extreme social and economic disparity among people, and consequently, those with means can avail the best medical care in the same or other countries (3).
The choice of kidney replacement therapy (KRT) depends on both state policy and funding. A “peritoneal dialysis (PD)-first” policy is a strategy used in Hong Kong, where it is subsidized, and Thailand (4), where it is free if the patients opts for the PD-first policy; however, the patient has to pay if hemodialysis (HD) is chosen as the first therapy. In Nepal, Indonesia, Vietnam, and Philippines, entire costs of PD for suitable patients are covered; in Sri Lanka and Myanmar, PD is partially covered. In India, Pakistan, and Bangladesh, funding is available only to state employees and below poverty-line patients (1, 5).
There is great contrast in and diversity of care available to patients in the developing world who have ESKD (6). Most patients have no or only meager resources to pay the recurring cost of ESKD care (7).
The lower frequency of HD sessions implemented is a reflection of poor socioeconomic status coupled with poor education (8). The average distribution of dialysis schedules in a week between HEs and LEs, respectively, is as follows: >2 HD sessions (84% vs. 25%), 2 HD sessions (16% vs. 64%), and <2 HD sessions (0.2% vs. 11.2%). HD sessions of <2/week were 56 times more common in LEs (median LE 14.7 vs. HE 0.4) (1) (Table 1).
ESKD hemodialysis session frequency in SEAR and SACs
The preventive measures for CKD are more cost effective at the community level, with successful implementation of a comprehensive yet inexpensive screening program to prevent CKD and treatment with low-cost medicines for hypertension and diabetes (9). In Taiwan, a kidney health promotion project, costing $15 million/year since 2003, has reduced the annual incidence of ESKD from a peak of 432 per million in 2005 to 361 per million in 2010 (10). An International Society of Nephrology (ISN) Global Kidney Policy Forum (Focus on South East Asia and Oceania 2019) recommended “developing appropriate solutions and driving innovation towards patient-centered, self-sufficient care” to give priority to preventive measures (11).
Equitable kidney care will be achieved by investment in people and processes (12) (Table 2).
What a few countries are doing to mitigate the problem of kidney care services in South East Asia
References
- 1.↑
Alexander S, et al. Impact of national economy and policies on end-stage kidney care in South Asia and Southeast Asia. Int J Nephrol 2021; 2021:6665901. doi: 10.1155/2021/6665901
- 2.↑
Luyckx VA, et al. Dialysis funding, eligibility, procurement, and protocols in low- and middle-income settings: Results from the International Society of Nephrology collection survey. Kidney Int Suppl(2011) 2020; 10:E10–E18. doi: 10.1016/j.kisu.2019.11.005.
- 3.↑
Jha V, et al. The state of nephrology in South Asia. Kidney Int 2019; 95:31–37. doi: 10.1016/j.kint.2018.09.001
- 4.↑
Kwong VW-K, et al. Peritoneal dialysis in Asia. Kidney Dis (Basel) 2015; 1:147–156. doi: 10.1159/000439193
- 5.↑
Tang SCW, et al. Dialysis care and dialysis funding in Asia. Am J Kidney Dis 2020; 75:772–781. doi: 10.1053/j.ajkd.2019.08.005
- 6.↑
Kher V. End-stage renal disease in developing countries. Kidney Int 2002; 62:350–362. doi: 10.1046/j.1523-1755.2002.00426.x
- 7.↑
Bharati J, Jha V. Global dialysis perspective: India. Kidney360 2020; 1:1143–1147. https://kidney360.asnjournals.org/content/1/10/1143
- 8.↑
Dhaidan FA. Prevalence of end stage renal disease and associated conditions in hemodialysis Iraqi patients. Int J Res Med Sci 2018; 6:1515–1518. https://msjonline.org/index.php/ijrms/article/view/4941
- 9.↑
Mani MK. Experience with a program for prevention of chronic renal failure in India. Kidney Int 2005; 67 (Suppl 94):S75–S78. doi: 10.1111/j.1523-1755.2005.09419.x
- 10.↑
Jha V, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013; 382:260–272. doi: 10.1016/S0140-6736(13)60687-X
- 11.↑
International Society of Nephrology. ISN Global Kidney Policy Forum Series: Focus on South East Asia and Oceania 2019. April 12, 2019. https://www.theisn.org/wp-content/uploads/2021/06/Melbourne-2019-GKPF-Conclusions.pdf
- 12.↑
Divyaveer SS, et al. International Society of Nephrology Global Kidney Health Atlas: Structures, organization, and services for the management of kidney failure in South Asia. Kidney Int Suppl(2011) 2021; 11 : E97–E105. doi: 10.1016/j.kisu.2021.01.006
- 13.
Jha V. Current status of end-stage renal disease care in India and Pakistan. Kidney Int Suppl 2013; 3:P157–P160. https://www.kisupplements.org/article/S2157-1716(15)31134-5/fulltext
- 14.
Mazhar F, et al. Problems associated with access to renal replacement therapy: Experience of the Sindh Institute of Urology and Transplantation. Exp Clin Transplant 2017; 15 (Suppl 1):46–49. doi: 10.6002/ect.mesot2016.O27
- 15.
Ministry of Health & Family Welfare, Government of India. National Dialysis Programme under National Health Mission. April 5, 2016. https://main.mohfw.gov.in/sites/default/files/Pradhan%20Mantri%20National%20Dialysis%20Programme%20under%20NHM_0.pdf
