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

Schmeißer, Alexander; Jasuja, Sanjiv; Gallieni, Maurizio; Sahay, Manisha; Rana, Devinder Singh; Jha, Vivekanand; Verma, Shalini; Ramachandran, Raja; Bhargava, Vinant; Sagar, Gaurav; Bahl, Anupam; Mostafi, Mamun; Pisharam, Jayakrishnan K.; Tang, Sydney C. W.; Jacob, C. K.; Gunawan, Atma; Leong, Goh Bak; Thwin, Khin Thida; Agrawal, Rajendra K.; Vareesangthip, Kriengsak; Tanchanco, Roberto; Choong, Lina Hui Lin; Herath, Chula; Lin, Chih Ching; Cuong, Nguyen T; Haian, Ha Phan; Akhtar, Syed Fazal; AlSahow, Ali; Rajapurkar, Mohan; Kher, Vijay; Mehta, Hemant; Bhalla, Anil Kumar; Khanna, Umesh; Ray, Deepak S; Puri, Sonika; Jain, Himanshu; Lydia, Aida; Vachharajani, Tushar J.

doi:10.1155/2021/6665901

Cited by 7 publications

(9 citation statements)

References 40 publications

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“…Although the prevalence of dialysis is high in Taiwan, the percentage of ESRD patients undergoing kidney transplantation is as low as 4.1%. It is much lower than that in the United States (29.3%), Singapore (18.3%), and Hong Kong (39%) (9)(10)(11). Without kidney transplantation, the pathogenesis of SHPT cannot be interrupted, and recurrence can be expected.…”

Section: Introductionmentioning

confidence: 75%

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

et al. 2023

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BackgroundSecondary hyperparathyroidism (SHPT) is a common condition in patients with end-stage renal disease (ESRD) who are on dialysis. Parathyroidectomy is a treatment for patients when medical therapy has failed. Recurrence may occur and is indicated for further surgery in the era of improved quality of care for ESRD patients.MethodsWe identified, 1060 patients undergoing parathyroidectomy from January, 2011 to June, 2020. After excluding patients without regular check-up at our institute, primary hyperparathyroidism, or malignancy, 504 patients were enrolled. Sixty-two patients (12.3%, 62/504) were then excluded due to persistent SHPT even after the first parathyroidectomy. We aimed to identify risk factors for recurrent SHPT after the first surgery.ResultsDuring the study period, 20% of patients who underwent parathyroidectomy at our institute (in, 2019) was due to recurrence after a previous parathyroidectomy. There were 442 patients eligible for analysis of recurrence after excluding patients with the persistent disease (n = 62). While 44 patients (9.95%) had recurrence, 398 patients did not. Significant risk factors for recurrent SHPT within 5 years after the first parathyroidectomy, including dialysis start time to first operation time < 3 years (p = 0.046), postoperative PTH >106.5 pg/mL (p < 0.001), and postoperative phosphorus> 5.9 mg/dL (p = 0.016), were identified by multivariate analysis.ConclusionsThe starting time of dialysis to first operation time < 3 years in the patients with dialysis, postoperative PTH> 106.5 pg/mL, and postoperative phosphorus> 5.9 mg/dL tended to have a higher risk for recurrent SHPT within 5 years after primary treatment.

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Section: Introductionmentioning

confidence: 75%

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

et al. 2023

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“…In most APR coun- with a country's GDP 17,33 ; LICs and LMICs from SA and SEA are reported to have poorer dialysis infrastructure and inadequate manpower resulting in higher dialysis dropout rates. 12 There were limitations to our study. Data from 10 out of 21 countries were collected from national registries whereas responses from the remaining countries were provided based on the data available from various published/non-published local or regional studies or an educated guesstimate.…”

Section: Discussionmentioning

confidence: 89%

“…Our previous publications were limited to representative countries from South Asia (SA) and South-East Asia (SEA). [10][11][12][13] Here, we report a multinational survey-based study, that collected data from countries from the APR concerning the available dialysis facilities, the ability of a nephrologist to create or treat dysfunctional dialysis access and run training programs. Responses received from 21 countries were provided based on the data available from national disease registries, local and regional studies, or an educated guesstimate of the problem.…”

Section: Introductionmentioning

confidence: 99%

“…There is a paucity of data regarding the practice of DA‐related IN procedures amongst nephrologists, especially from the countries in the Asia‐Pacific Region (APR). Our previous publications were limited to representative countries from South Asia (SA) and South‐East Asia (SEA) 10–13 . Here, we report a multinational survey‐based study, that collected data from countries from the APR concerning the available dialysis facilities, the ability of a nephrologist to create or treat dysfunctional dialysis access and run training programs.…”

Section: Introductionmentioning

confidence: 99%

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Practice of dialysis access interventional nephrology procedures in the Asia‐Pacific region: Getting lay of the land

Jasuja,

Gallieni,

Jha

et al. 2023

Nephrology

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AimThis cross‐sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia‐Pacific Region (APR), specifically related to dialysis access (DA).MethodsThe Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia‐Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey.ResultsTwenty‐one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access‐related IN procedures, primarily the placement of non‐tunnelled central catheters (n‐TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico‐legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel.ConclusionThe practice of dialysis access‐related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access‐related IN is constrained by a lack of a skilled workforce and finances.

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“…In a recently published study, the cost of annual KRT therapy surpassed the annual per capita income in LI & LMI countries. 1,22 The lower cost of PD in LI& LMI could also be attributed to lower frequency of prescribed PD, limited use of automated PD and lower costs of transportation, labour and storage. Since the cumulative annual cost of PD in LI & LMI countries exceed the PCI coupled with a significant out-ofpocket expenditure, the scope of PD centric KRT interventions definitely seems a challenge there.…”

Section: Pd Versus Hd Cost Impact and Scopementioning

confidence: 99%

Peritoneal dialysis: Status report in South and South East Asia

et al. 2021

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Background: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. Methods: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. Results: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI -US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. Conclusion: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.

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

Cited by 7 publications

References 40 publications

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

Practice of dialysis access interventional nephrology procedures in the Asia‐Pacific region: Getting lay of the land

Peritoneal dialysis: Status report in South and South East Asia

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