The achieved standard of renal replacement therapy (RRT) in Tehran province, Iran is acceptable and in some aspects is comparable with European countries, but the number of ESRD patients is increasing in Tehran and worldwide. Increases in the number of HD centres, machines, shifts and kidney transplantations are taking place but cannot keep pace with the increasing number of patients. It is highly recommended that we try to increase peritoneal dialysis (PD) coverage and cadaveric transplantation, while keeping in mind that the prevalent population of individuals with CKD is estimated to be at least 20 times the number with ESRD. It is not too ambitious to consider CKD prevention, and we should place initial focus on strategies and treatments that slow disease progression, in order to postpone RRT.

The purpose of this study was to assess the health service cost of hemodialysis (HD) delivered at hospitals in Iran as a developing country with a well-defined program of renal replacement therapy. A cost analysis was performed from the viewpoint of the 2 hospitals, with 3 shifts and full chairs, on current practice for dialysis maintenance. Cost and patient data were collected in 2006 and from April 1 to May 31, 2007, respectively. A total of 22,464 HD sessions were performed and 247 patients were studied during the study period. The reference year for the value of USD for different mentioned costs was 2006. Health care sector costs associated with each HD session were estimated at US$78.87. Most of the total maintenance expenditure was made up of medical supplies (36.19%), with dialyzers as the major cost driver. Staff salaries represented 17% of the cost and fixed direct capital costs accounted for 21.4%. Of the family members, 32.4% accompanied their patients. The mean cost for transportation of patients and accompanied person was US$3.15 +/- 2.83 and US$1.5 +/- 0.29, respectively. These findings are important in the light of limited available resources coupled with the increasing prevalence of kidney failure. A major attempt should also be made to increase peritoneal dialysis coverage as in some centers we cannot keep all chairs full, especially in some vast areas. It is highly recommended to place initial focus on strategies and treatments that slow disease progression, to postpone renal replacement therapy to save resources.