TY - JOUR
T1 - Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia
AU - Alexander, Suceena
AU - Jasuja, Sanjiv
AU - Gallieni, Maurizio
AU - Sahay, Manisha
AU - Rana, Devender S.
AU - Jha, Vivekanand
AU - Verma, Shalini
AU - Ramachandran, Raja
AU - Bhargava, Vinant
AU - Sagar, Gaurav
AU - Bahl, Anupam
AU - Mostafi, Mamun
AU - Pisharam, Jayakrishnan K.
AU - Tang, Sydney C.W.
AU - Jacob, Chakko
AU - Gunawan, Atma
AU - Leong, Goh B.
AU - Thwin, Khin T.
AU - Agrawal, Rajendra K.
AU - Vareesangthip, Kriengsak
AU - Tanchanco, Roberto
AU - Choong, Lina H.L.
AU - Herath, Chula
AU - Lin, Chih C.
AU - Cuong, Nguyen T.
AU - Haian, Ha P.
AU - Akhtar, Syed F.
AU - Alsahow, Ali
AU - Rajapurkar, Mohan M.
AU - Kher, Vijay
AU - Mehta, Hemant
AU - Bhalla, Anil K.
AU - Khanna, Umesh B.
AU - Ray, Deepak S.
AU - Puri, Sonika
AU - Jain, Himanshu
AU - Lydia, Aida
AU - Vachharajani, Tushar
N1 - Publisher Copyright:
© 2021 Suceena Alexander et al.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85106388483&partnerID=8YFLogxK
U2 - 10.1155/2021/6665901
DO - 10.1155/2021/6665901
M3 - Review article
AN - SCOPUS:85106388483
SN - 2090-214X
VL - 2021
JO - International Journal of Nephrology
JF - International Journal of Nephrology
M1 - 6665901
ER -