Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia
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 L...
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2021-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2021/6665901 |
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| author | Suceena Alexander Sanjiv Jasuja Maurizio Gallieni Manisha Sahay Devender S. Rana Vivekanand Jha Shalini Verma Raja Ramachandran Vinant Bhargava Gaurav Sagar Anupam Bahl Mamun Mostafi Jayakrishnan K Pisharam Sydney C. W. Tang Chakko Jacob Atma Gunawan Goh B. Leong Khin T. Thwin Rajendra K Agrawal Kriengsak Vareesangthip Roberto Tanchanco Lina H. L. Choong Chula Herath Chih C. Lin Nguyen T. Cuong Ha P. Haian Syed F Akhtar Ali Alsahow Mohan M. Rajapurkar Vijay Kher Hemant Mehta Anil K. Bhalla Umesh B. Khanna Deepak S. Ray Sonika Puri Himanshu Jain Aida Lydia Tushar Vachharajani |
| author_facet | Suceena Alexander Sanjiv Jasuja Maurizio Gallieni Manisha Sahay Devender S. Rana Vivekanand Jha Shalini Verma Raja Ramachandran Vinant Bhargava Gaurav Sagar Anupam Bahl Mamun Mostafi Jayakrishnan K Pisharam Sydney C. W. Tang Chakko Jacob Atma Gunawan Goh B. Leong Khin T. Thwin Rajendra K Agrawal Kriengsak Vareesangthip Roberto Tanchanco Lina H. L. Choong Chula Herath Chih C. Lin Nguyen T. Cuong Ha P. Haian Syed F Akhtar Ali Alsahow Mohan M. Rajapurkar Vijay Kher Hemant Mehta Anil K. Bhalla Umesh B. Khanna Deepak S. Ray Sonika Puri Himanshu Jain Aida Lydia Tushar Vachharajani |
| author_sort | Suceena Alexander |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-10d48738a00041b5a98dfcd32fdaffd8 |
| institution | OA Journals |
| issn | 2090-214X 2090-2158 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-10d48738a00041b5a98dfcd32fdaffd82025-08-20T02:02:16ZengWileyInternational Journal of Nephrology2090-214X2090-21582021-01-01202110.1155/2021/66659016665901Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast AsiaSuceena Alexander0Sanjiv Jasuja1Maurizio Gallieni2Manisha Sahay3Devender S. Rana4Vivekanand Jha5Shalini Verma6Raja Ramachandran7Vinant Bhargava8Gaurav Sagar9Anupam Bahl10Mamun Mostafi11Jayakrishnan K Pisharam12Sydney C. W. Tang13Chakko Jacob14Atma Gunawan15Goh B. Leong16Khin T. Thwin17Rajendra K Agrawal18Kriengsak Vareesangthip19Roberto Tanchanco20Lina H. L. Choong21Chula Herath22Chih C. Lin23Nguyen T. Cuong24Ha P. Haian25Syed F Akhtar26Ali Alsahow27Mohan M. Rajapurkar28Vijay Kher29Hemant Mehta30Anil K. Bhalla31Umesh B. Khanna32Deepak S. Ray33Sonika Puri34Himanshu Jain35Aida Lydia36Tushar Vachharajani37Department of Nephrology, Christian Medical College, Vellore 632004, IndiaDepartment of Nephrology, Indraprastha Apollo Hospital, Delhi 110020, IndiaDepartment of Nephrology, “L. Sacco” Department of Biomedical and Clinical Sciences, University of Milano, Milan 20157, ItalyDepartment of Nephrology, Osmania General Hospital, Hyderabad 500012, IndiaDepartment of Nephrology, Sir Gangaram Hospital, Delhi 110060, IndiaDepartment of Nephrology, George Institute of Global Health, Delhi 110025, IndiaClinical Research, AVATAR Foundation, New Delhi 110025, IndiaDepartment of Nephrology, PGIMER, Chandigarh 160012, IndiaDepartment of Nephrology, Sir Gangaram Hospital, Delhi 110060, IndiaDepartment of Nephrology, Indraprastha Apollo Hospital, Delhi 110020, IndiaDepartment of Nephrology, Indraprastha Apollo Hospital, Delhi 110020, IndiaDepartment of Nephrology, Armed Forces Medical College, Dhaka Cantonment, Dhaka 1206, BangladeshDepartment of Nephrology, Ministry of Health, Brunei Darussalam Medical Services, BB3910, Brunei DarussalamDepartment of Nephrology, Queen Mary Hospital, Pok Fu Lam Road DD3LM 1969, Pok Fu Lam, Hong KongDepartment of Nephrology, Bangalore Baptist Hospital, Bengaluru 560024, IndiaDepartment of Nephrology, Brawijaya University, Malang 65145, IndonesiaDepartment of Nephrology, Serdang Hospital, Selangor 43000, MalaysiaDepartment of Nephrology, University of Medicine, North Okkalapa 11031, Yangon, MyanmarDepartment of Nephrology, Bir Hospital, Kathmandu 44600, NepalDepartment of Nephrology, Siriraj Hospital, Mahidol University, Bangkok 10700, ThailandDepartment of Nephrology, The Medical City, Pasig City 1605, PhilippinesDepartment of Nephrology, Singapore General Hospital 169608, SingaporeDepartment of Nephrology, Sri Jayewardenepura General Hospital, Nugegoda 10100, Sri LankaDepartment of Nephrology, Taipei Veterans General Hospital, Taipei City 11217, TaiwanDepartment of Kidney Disease and Dialysis, Vietduc University Hospital, No 40, Trangathi Street, Hanoi, VietnamDepartment of Nephrology, Viet Duc University Hospital, Hanoi 40, VietnamDepartment of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, PakistanDepartment of Nephrology, Jahra Hospital, Al Jahra, KuwaitDepartment of Nephrology, Muljibhai Patel Urological Hospital, Nadiad 387001, IndiaDepartment of Nephrology, Medanta Hospital, Gurugram 122006, IndiaDepartment of Nephrology, Lilawati Hospital, Mumbai 400050, IndiaDepartment of Nephrology, Sir Gangaram Hospital, Delhi 110060, IndiaDepartment of Nephrology, Lancelot Kidney & GI Centre in Borivali West, Mumbai 400092, IndiaDepartment of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata 700026, IndiaDepartment of Nephrology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USAClinical Research, AVATAR Foundation, New Delhi 110025, IndiaDepartment of Nephrology and Hypertension, Universitas Indonesia-Dr Cipto Mangunkusumo Hospital, Salemba 10430, Jakarta, IndonesiaDepartment of Nephrology, Cleveland Clinic, Cleveland, OH 44195, USABackground. 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.http://dx.doi.org/10.1155/2021/6665901 |
| spellingShingle | Suceena Alexander Sanjiv Jasuja Maurizio Gallieni Manisha Sahay Devender S. Rana Vivekanand Jha Shalini Verma Raja Ramachandran Vinant Bhargava Gaurav Sagar Anupam Bahl Mamun Mostafi Jayakrishnan K Pisharam Sydney C. W. Tang Chakko Jacob Atma Gunawan Goh B. Leong Khin T. Thwin Rajendra K Agrawal Kriengsak Vareesangthip Roberto Tanchanco Lina H. L. Choong Chula Herath Chih C. Lin Nguyen T. Cuong Ha P. Haian Syed F Akhtar Ali Alsahow Mohan M. Rajapurkar Vijay Kher Hemant Mehta Anil K. Bhalla Umesh B. Khanna Deepak S. Ray Sonika Puri Himanshu Jain Aida Lydia Tushar Vachharajani Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia International Journal of Nephrology |
| title | Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia |
| title_full | Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia |
| title_fullStr | Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia |
| title_full_unstemmed | Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia |
| title_short | Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia |
| title_sort | impact of national economy and policies on end stage kidney care in south asia and southeast asia |
| url | http://dx.doi.org/10.1155/2021/6665901 |
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