Considerations on equity in management of end-stage kidney disease in low- and middle-income countries

Wim Van Biesen; Vivekanand Jha; Ali K Abu-Alfa; Sharon P Andreoli; Gloria Ashuntantang; Bassam Bernieh; Edwina Brown; Yuqing Chen; Rosanna Coppo; Cecile Couchoud; Brett Cullis; Walter Douthat; Felicia U Eke; Brenda Hemmelgarn; Fan Fan Hou; Nathan W Levin; Valerie A Luyckx; Rachael L Morton; Mohammed Rafique Moosa; Fliss E M Murtagh; Marie Richards; Eric Rondeau; Daniel Schneditz; Kamal D Shah; Vladimir Tesar; Karen Yeates; Guillermo Garcia Garcia

doi:10.1016/j.kisu.2019.11.004

Considerations on equity in management of end-stage kidney disease in low- and middle-income countries

Kidney Int Suppl (2011). 2020 Mar;10(1):e63-e71. doi: 10.1016/j.kisu.2019.11.004. Epub 2020 Feb 19.

Authors

Wim Van Biesen¹, Vivekanand Jha^{2

3

4}, Ali K Abu-Alfa⁵, Sharon P Andreoli⁶, Gloria Ashuntantang⁷, Bassam Bernieh^{8

9}, Edwina Brown¹⁰, Yuqing Chen^{11

12

13}, Rosanna Coppo¹⁴, Cecile Couchoud¹⁵, Brett Cullis¹⁶, Walter Douthat¹⁷, Felicia U Eke¹⁸, Brenda Hemmelgarn^{19

20}, Fan Fan Hou²¹, Nathan W Levin²², Valerie A Luyckx^{23

24}, Rachael L Morton²⁵, Mohammed Rafique Moosa²⁶, Fliss E M Murtagh²⁷, Marie Richards²⁸, Eric Rondeau^{29

30}, Daniel Schneditz³¹, Kamal D Shah³², Vladimir Tesar³³, Karen Yeates³⁴, Guillermo Garcia Garcia³⁵

Affiliations

¹ Nephrology Department, Ghent University Hospital, Ghent, Belgium.
² George Institute for Global Health India, New Delhi, India.
³ Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
⁴ Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
⁵ Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁶ Department of Pediatrics, Pediatric Nephrology, Indiana University Medical Center, Indianapolis, Indiana, USA.
⁷ Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde I, Cameroon.
⁸ Home Hemodialysis for Home Dialysis, Al Ain, United Arab Emirates.
⁹ The Heart Medical Center, Al Ain, United Arab Emirates.
¹⁰ Imperial College Healthcare National Health Service Trust, London, UK.
¹¹ Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
¹² Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
¹³ Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.
¹⁴ Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy.
¹⁵ French Renal Epidemiology and Information Network (REIN) Registry, Biomedicine Agency, Paris, France.
¹⁶ Renal Unit, Greys Hospital, Pietermaritzburg, South Africa.
¹⁷ Hospital Privado-Universitario de Cordoba and Instituto Universitario de Ciencias Biomédicas, Cordoba, Argentina.
¹⁸ Department of Pediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
¹⁹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁰ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
²¹ State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
²² Mount Sinai Icahn School of Medicine, New York, New York, USA.
²³ Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.
²⁴ Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁵ National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
²⁶ Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
²⁷ Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
²⁸ SEHA Dialysis Services, Abu Dhabi, United Arab Emirates.
²⁹ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
³⁰ Sorbonne Université, Paris, France.
³¹ Otto Loewi Research Center, Medical University of Graz, Graz, Austria.
³² NephroPlus Dialysis Centres, Hyderabad, India.
³³ Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic.
³⁴ Division of Nephrology, Queen's University, Kingston, Ontario, Canada.
³⁵ Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico.

Abstract

Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and delivery models, and nature of KRT prioritization (transplantation, hemodialysis or peritoneal dialysis, and conservative care). Implementation of KRT programs has the potential to exacerbate inequity unless equity is deliberately addressed. In this review, we summarize discussions on equitable provision of KRT in low- and middle-income countries and suggest areas for future research.

Keywords: end-stage kidney disease; equity; ethical framework; kidney replacement therapy; reimbursement; social justice.

Publication types

Review