Chronic kidney disease (CKD) in disadvantaged populations

Garcia-Garcia, Guillermo; Jha, Vivekanand; Li, P. K. Tao; Couser, William G.; Erk, Timur; Zakharova, Elena; Segantini, Luca; Shay, Paul L.; Riella, Miguel C.; Osafo, Charlotte; Dupuis, Sophie; Kernahan, Charles

doi:10.1093/ckj/sfu124

Cited by 47 publications

(41 citation statements)

References 43 publications

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“…Together with these epidemiologic transitions, poor access to primary and preventative health care hastens the progression of diseases like CKD (Garcia-Garcia et al 2015). Although some public primary health care does exist in Guatemala and is free to all citizens, it is designed to address acute and episodic conditions, and is not resourced to care for people with chronic illnesses like diabetes or CKD (Maupin 2009).…”

Section: End-stage Renal Disease In Rural Guatemalamentioning

confidence: 99%

Fluid illness

Moore¹,

Baird²,

Rohloff³

2019

MAT

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In response to the rising rate of end-stage renal disease (ESRD) in Guatemala, the public health system established a national community-based dialysis program to enable people living in rural areas to complete treatment in their homes. Here we explore how this newly available, life-prolonging technology has altered local worlds by transforming ESRD from an acute, life-ending illness into a managed chronic condition with an uncertain trajectory. Through case studies, we describe how living with dialysis influences family relations and caregiving in rural Guatemala. We find that dialysis interacts with an insufficient health care system, one that avoids life-ending complications but does not sufficiently manage lifealtering symptoms. In addition, the need to care for people with ESRD for an uncertain amount of time may disrupt and strain family-based caregiving networks. Amid this meager health and social welfare infrastructure, life on dialysis exacerbates the chronic insecurity and structural inequality of life in postwar Guatemala. As both life and illness are prolonged through dialysis, the unceasing demands of the treatment and illness strain the webs of obligation and care that Guatemalan families and communities have developed to adapt to their decentralized and fragmented public health care system.

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Section: End-stage Renal Disease In Rural Guatemalamentioning

confidence: 99%

Fluid illness

Moore¹,

Baird²,

Rohloff³

2019

MAT

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“…According to the US Annual Data Report 2017, there were approximately 97000 patients registered in the waiting list; of these, 60% were eligible for a transplant if a kidney was offered to them (15). Patients would remain on the waiting list for eight to 12 years, which has caused more than 4000 kidney patients in the United States to die before they even got a chance to receive a kidney (16). Based on a recent study, by 2030 the number of people receiving RRT around the world is predicted to increase to 5.4 million.…”

Section: Kidney Transplantation In Iran and Other Countriesmentioning

confidence: 99%

Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review

2019

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Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran.Evidence Acquisition: This narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model. Results:Overall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank. Conclusions:The transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

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“…Part of the differences in incidence is explained by their higher frequency in disadvantaged populations throughout the world [ 43 ]. Indeed this is the subject of the World Kidney Day 2015 [ 44 ], and the causes are multifactorial but insufficient implementation of routine clinical care, standard living conditions and education of the population and authorities is part of the problem.…”

Section: Current Clinical Practice Issues In Nephrologymentioning

confidence: 99%

Translational nephrology: what translational research is and a bird's-eye view on translational research in nephrology

Ortíz

2015

Clinical Kidney Journal

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The ultimate aim of biomedical research is to preserve health and improve patient outcomes. However, by a variety of measures, preservation of kidney health and patient outcomes in kidney disease are suboptimal. Severe acute kidney injury has been treated solely by renal replacement therapy for over 50 years and mortality still hovers at around 50%. Worldwide deaths from chronic kidney disease (CKD) increased by 80% in 20 years––one of the greatest increases among major causes of death. This dramatic data concur with huge advances in the cellular and molecular pathophysiology of kidney disease and its consequences. The gap appears to be the result of sequential roadblocks that impede an adequate flow from basic research to clinical development [translational research type 1 (T1), bench-to-bed and back] and from clinical development to clinical practice and widespread implementation (translational research T2) that supported by healthcare policy-making reaches all levels of society throughout the globe (sometimes called translational research T3). Thus, it is more than 10 years since the introduction of the last new-concept drug for CKD patients, cinacalcet; and 30 years since the introduction of reninangiotensin system (RAS) blockade, the current mainstay to prevent progression of CKD, illustrating the basic science-clinical practice disconnect. Roadblocks from clinical advances to widespread implementation, together with lag time-to-benefit may underlie the 20 years since the description of the antiproteinuric effect of RAS blockade to the observation of decreased age-adjusted incidence of endstage renal disease due to diabetic kidney disease. Only a correct understanding of the roadblocks in translational medicine and a full embracement of a translational research culture will spread the benefits of the biomedical revolution to its ultimate destinatary, the society.

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Chronic kidney disease (CKD) in disadvantaged populations

Cited by 47 publications

References 43 publications

Fluid illness

Fluid illness

Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review

Translational nephrology: what translational research is and a bird's-eye view on translational research in nephrology

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