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

Sustainable Development Goals relevant to kidney health: an update on progress

“…Globally, the prevalence of KRT is proportional to GDP per capita up to ~ US$14,000, after which it plateaus, suggesting that, in countries with a GDP per capita above US$14,000, access to dialysis is more equitable and less dependent on the patient's ability to pay or restricted service provision 139 . Some countries with lower GDPs per capita, such as Thailand (2018 GDP per capita US$7,273) and Colombia (2019 GDP per capita US$6,498), have implemented deliberate policies to include dialysis under UHC 140 . Following the inclusion of KRT under UHC in these countries, health expenditure per capita rose, but poverty rates and catastrophic health expenditure declined significantly 140,141 .…”

“…Some countries with lower GDPs per capita, such as Thailand (2018 GDP per capita US$7,273) and Colombia (2019 GDP per capita US$6,498), have implemented deliberate policies to include dialysis under UHC 140 . Following the inclusion of KRT under UHC in these countries, health expenditure per capita rose, but poverty rates and catastrophic health expenditure declined significantly 140,141 . 'Peritoneal dialysis first' programmes, as implemented in Thailand, might permit the most appropriate use of precious resources to provide affordable quality and sustainable chronic dialysis for those in need, if costs can be contained 142 .…”

Strategic plan for integrated care of patients with kidney failure

“…Proposed activities included data capture, policy creation, definition of quality standards, evidence-based guidance, capacitybuilding, implementation, and research, as well as a performance measurement framework to assess progress. [3][4][5][6][7][8][9][10][11][12][13] In parallel, the ISN is working with the World Health Organization (WHO) to develop a technical package for those wishing to start or expand dialysis services.…”

The second Global Kidney Health Summit outputs: developing a strategic plan to increase access to integrated end-stage kidney disease care worldwide

“…9 Van Biesen and others examine the prevalent inequities in ESKD treatment provision around the world through an economic lens and discuss the need for focusing on availability, affordability, and acceptability in providing care. 10 Luyckx et al discuss ethical dilemmas of ESKD through the 4 core ethical principles of harm/benefit balance, social justice, respect of autonomy, and the need for transparency, at the level of individual patients, the community, and policy. 11 With respect to transplantation, O'Connell et al emphasize the crucial role of appropriate legislation, community engagement, and adequate investment, especially in a highly skilled workforce, as the key elements for service development.…”