Inequalities in access to pediatric ESRD care: a global health challenge

Abstract

The increasing attention paid to chronic kidney disease (CKD) as a major cause of mortality and disability, as well as the advances in management of CKD in children, have created a growing demand for pediatric renal replacement therapy (RRT) worldwide. A study by Koch Nogueira and colleagues of children on the transplant waiting list showed large disparities in access to pediatric kidney transplantation between regions in Brazil. This finding raises a wider question about inequalities in access to CKD care in children. Here we review the available data on the global burden of end-stage renal disease in children, the need for pediatric RRT, and its actual provision worldwide. We focus on inequalities in access to renal care for children that currently exist between and within countries. Reduction in worldwide inequalities in access to RRT in children remains a challenge, which requires greater awareness and effective interventions and policies.

Burden, access and disparities in kidney disease

“…). Challenges may be even greater for families of children with ESRD, as many regions lack qualified pediatric care centers (Harambat & Ekulu ).…”

Non‐standard criteria donors in pediatric kidney transplantation

“…One of the challenges faced in improving this scenario is inequality of access to pediatric ESRD care, not only in Europe, but globally. Centers that perform this modality of treatment are able to meet no more than 10% of global needs …”

“…Centers that perform this modality of treatment are able to meet no more than 10% of global needs. 9 The scenario is similar in Brazil to the rest of the world, where organ supply cannot meet demand. For the country as a whole, median waiting time for transplantation is 7.0 months, whereas specifically for DD transplantations, median waiting time is 9.8 months.…”

Good outcome of the single‐center pediatric kidney transplant program in Abu Dhabi

“…The global incidence rates of RRT in children vary substantially, from 4 pmarp in developing to 14 pmarp in developed countries . The pediatric renal transplant incidence rate in 2008 was reported to be 0.77 pmp/y in the Middle East as compared to an average of 8 pmp/y in Europe .…”

“…1,3 The global incidence rates of RRT in children vary substantially, from 4 pmarp in developing to 14 pmarp in developed countries. 4 The pediatric renal transplant incidence rate in 2008 was reported to be 0.77 pmp/y in the Middle East as compared to an average of 8 pmp/y in Europe. 5 The United Arab Emirates (UAE) permits transplantation of human organs and tissues from both living donors and the deceased in accordance with the provisions specified in the Federal Decree Law No.…”