Developing nephrology programs in very low-resource settings: challenges in sustainability

Yeates, Karen; Ghosh, Sudakshina; Kilonzo, Kajiru

doi:10.1038/kisup.2013.14

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…The dialysis acceptance rate in this study is low and the chance of accessing renal transplantation either locally or abroad is extremely difficult. This finding is similar to what is obtainable in most of the developing countries of the world especially in many of the sub-Saharan African countries [ 9 – 11 , 21 ].…”

Section: Discussionsupporting

confidence: 89%

Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

Odetunde

Okafor

Uwaezuoke

et al. 2014

The Scientific World Journal

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A 5-year observational, retrospective study was conducted to evaluate the indications, the availability, the accessibility, the sustainability, and the outcome of children managed for acute kidney injury (AKI) and end stage kidney disease (ESKD) who required renal replacement therapy RRT in Enugu, southeast Nigeria. A total of 64 patients aged 5 months to 16 years required RRT, of which only 25 underwent RRT, giving an RRT accessibility rate of 39.1%. Eleven (44%) patients required chronic dialysis program/ renal transplant, of which only 1 (9.1%) accessed and sustained chronic hemodialysis, giving a dialysis acceptance rate of 9.1%. Fifty (78%) of the patients belonged to the low socioeconomic class. Thirty-three (51.5%) could not access RRT because of financial constraints and discharge against medical advice (DAMA); 6 (9.4%) died on admission while sourcing for funds to access the therapy; 5 (7.8%) died while on RRT; 9 (14.1%) improved and were discharged for follow-up; 1 (1.6%) improved and was discharged to be on chronic dialysis program while awaiting renal transplantation outside the country/clinic follow-up, while the remaining 10 (15.6%) were unable to sustain chronic dialysis program or access renal transplantation and were lost to follow-up. We conclude that RRT remains unaffordable within the subregion.

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Section: Discussionsupporting

confidence: 89%

Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

Odetunde

Okafor

Uwaezuoke

et al. 2014

The Scientific World Journal

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“…It is still unrecognized by many low-resource countries as a potentially devastating cause of morbidity and mortality in their population. 1 Globally, it has been estimated that more than 500 million individuals have CKD, defined by either kidney damage or glomerular filtration rate (GFR) < 60 mL/min/1.73 m 2 for greater or equal to 3 months, regardless of the cause. 2 End-stage renal disease (ESRD) is the last stage of CKD, which needs dialysis to maintain patient's lives.…”

Section: Introductionmentioning

confidence: 99%

<p>Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia</p>

Kassa¹,

Mekonnen²,

Kebede³

et al. 2020

CEOR

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Purpose: Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia. Patients and Methods: An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients' medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of <0.05 and a 95% CI were used to declare the significant variables. Results: The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value <0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value <0.001) and 12 visits/month (ex(b): 1.34, p-value <0.001), anemia (ex(b): 1.13, p-value <0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment. Conclusion: The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.

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“…1,2 Although Africa is estimated to host a three to four times higher burden of chronic kidney disease as compared with developed countries, treatment facilities are scarce, and shortage of human resources is a major impediment. 3,4 Increasing the number of trained health-care providers plays an important role in the management of kidney diseases. The International Society of Nephrology (ISN) has supported the training of more than 600 nephrologists 5 and has also supported the treatment of patients with kidney diseases in sub-Saharan Africa, particularly in acute peritoneal dialysis.…”

Section: Introductionmentioning

confidence: 99%

“…The International Society of Nephrology (ISN) has supported the training of more than 600 nephrologists 5 and has also supported the treatment of patients with kidney diseases in sub-Saharan Africa, particularly in acute peritoneal dialysis. 4 This has significantly improved nephrology services in the region.…”

Section: Introductionmentioning

confidence: 99%

Global collaboration bears fruit: Tanzania report

Fredrick

Ruggajo

Basu

et al. 2015

Kidney International

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Establishment of nephrology training in Tanzania. Seven candidates (one female) were trained in nephrology throughout this program, five from Tanzania and one each from Uganda and Ethiopia. The program recruited candidates with a general medicine or pediatrics background, and three of those trained were pediatricians. One candidate dropped from the program. The two candidates from Uganda and Ethiopia returned to their home institutions.

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Developing nephrology programs in very low-resource settings: challenges in sustainability

Cited by 12 publications

References 15 publications

Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

<p>Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia</p>

Global collaboration bears fruit: Tanzania report

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