Inequality in pediatric kidney transplantation in Brazil

Nogueira, Paulo Roberto; Carvalho, Maria Fernanda; Feltran, Luciana de Santis; Konstantyner, Túlio; Sesso, Ricardo

doi:10.1007/s00467-015-3226-z

Cited by 17 publications

(17 citation statements)

References 27 publications

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“…Despite being the world's 7th largest economy and having experienced social progress in the past decades, Brazil, like many other Latin American countries, still has to overcome extreme inequalities that leave more than 20 % of its population below the poverty line. In an effort to investigate potential inequalities in access to pediatric kidney transplantation in Brazil, Koch Nogueira and colleagues examined the probability of receiving a deceased donor transplant using competing risks regression models [3]. In an article recently published in Pediatric Nephrology, they report that, despite a nationally regulated allocation system, children from the North and the Midwest macroregions of Brazil have a 3-4 times lower probability of getting a deceased donor transplant than children from the South and Southeast macroregions [3].…”

Section: Inequalities In Access To Transplantationmentioning

confidence: 99%

“…In an effort to investigate potential inequalities in access to pediatric kidney transplantation in Brazil, Koch Nogueira and colleagues examined the probability of receiving a deceased donor transplant using competing risks regression models [3]. In an article recently published in Pediatric Nephrology, they report that, despite a nationally regulated allocation system, children from the North and the Midwest macroregions of Brazil have a 3-4 times lower probability of getting a deceased donor transplant than children from the South and Southeast macroregions [3]. It is argued that this is not compensated by a higher living donor transplant rate and nor does it completely reflect the underlying disparities in pediatric ESRD incidence [31].…”

Section: Inequalities In Access To Transplantationmentioning

confidence: 99%

“…In an article recently published in Pediatric Nephrology, Koch Nogueira and colleagues report striking disparities in access to kidney transplantation across Brazil with children from two regions having far lower chances of getting a deceased donor transplant than those from two other regions [3]. For the authors, these results are attributable to economic and organizational issues.…”

Section: Introductionmentioning

confidence: 99%

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Inequalities in access to pediatric ESRD care: a global health challenge

Harambat

Ekulu

2015

Pediatr Nephrol

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The increasing attention paid to chronic kidney disease (CKD) as a major cause of mortality and disability, as well as the advances in management of CKD in children, have created a growing demand for pediatric renal replacement therapy (RRT) worldwide. A study by Koch Nogueira and colleagues of children on the transplant waiting list showed large disparities in access to pediatric kidney transplantation between regions in Brazil. This finding raises a wider question about inequalities in access to CKD care in children. Here we review the available data on the global burden of end-stage renal disease in children, the need for pediatric RRT, and its actual provision worldwide. We focus on inequalities in access to renal care for children that currently exist between and within countries. Reduction in worldwide inequalities in access to RRT in children remains a challenge, which requires greater awareness and effective interventions and policies.

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Section: Inequalities In Access To Transplantationmentioning

confidence: 99%

Section: Inequalities In Access To Transplantationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inequalities in access to pediatric ESRD care: a global health challenge

Harambat

Ekulu

2015

Pediatr Nephrol

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“…This therapeutic modality increases patient survival, development and growth, improves quality of life, and also has economic benefits. However, the demand for kidney transplants continues to outstrip supply worldwide, even in the pediatric scenario, where priority policies are usually adopted …”

Section: Introductionmentioning

confidence: 99%

“…For the country as a whole, median waiting time for transplantation is 7.0 months, whereas specifically for DD transplantations, median waiting time is 9.8 months. There are major inequalities between regions, with wait times of around 15.7 months in the North for instance . Besides this relatively lengthy waiting time, around 20% of children listed in 2015 had not received a transplant after 1 year…”

Section: Introductionmentioning

confidence: 99%

Non‐standard criteria donors in pediatric kidney transplantation

Pereira

Nogueira

2019

Pediatric Transplantation

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KT remains the treatment of choice for ESRD in children. However, the demand for kidney transplants continues to outstrip supply, even in the pediatric scenario. We reviewed the applicability of nonSCDs for pediatric KT. There is a lack of studies analyzing this modality among pediatric donors and recipients, where most conclusions are based on predictions from adult data. Nevertheless, marginal donors might be a reasonable option in selected cases. For example, the use of older LDs is an acceptable option, with outcomes comparable to SCDs. Organs donated after cardiac death represent another possibility, albeit with logistic, ethical, and legal limitations in some countries. AKI donors also constitute an option in special situations, although there are no pediatric data on these transplants. Likewise, there are no data on the use of expanded criteria donors in pediatric patients, but this appears not to be a good option, considering the compromised long‐term survival.

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Renal replacement therapy for children throughout the world: the need for a global registry

et al. 2017

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BackgroundTo describe the factors affecting the incidence of renal replacement therapy (RRT) among children, information from RRT registries is required. We aimed to give an overview of existing pediatric RRT registries worldwide, identify regions with a need to commence or increase data collection on pediatric RRT, and provide a rationale for developing a global RRT registry.MethodsA survey assessing pediatric RRT registry status was sent to International Pediatric Nephrology Associateion (IPNA) members in 127 countries in January 2016. The survey was complemented by a systematic literature search for active pediatric RRT registries.ResultsComplete survey responses were retrieved from 94 countries (representing 86.2% of the world childhood population), with 84 (81.2%) having the means to provide RRT to children, given that there are no other limitations such as financial, social, or religious restraints. Fifty-one (35.3%) countries had national registries for both dialysis and transplantation, nine (30.0%) either had a dialysis or a transplant registry, six participated in international registries only (2.7%), and in 18 (13.2%), children on RRT were not followed in any registry. The search identified 92 pediatric RRT registries, primarily national registries located in Europe, North America, and Asia.ConclusionsAlthough pediatric RRT can be provided in 84 countries representing 81.2% of the world’s childhood population, national pediatric RRT registries are unavailable in many countries. To improve knowledge about the incidence and outcomes of pediatric RRT around the globe, an international population-based pediatric RRT registry has recently been initiated.Electronic supplementary materialThe online version of this article (10.1007/s00467-017-3863-5) contains supplementary material, which is available to authorized users.

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Inequality in pediatric kidney transplantation in Brazil

Abstract: Factors of inequality in transplantation in Brazil are of macroeconomic origin, but there is room to reduce inequalities. Training existing transplant center professionals in the care of children could diminish the discrepancies.

Cited by 17 publications

References 27 publications

Inequalities in access to pediatric ESRD care: a global health challenge

Inequalities in access to pediatric ESRD care: a global health challenge

Non‐standard criteria donors in pediatric kidney transplantation

Renal replacement therapy for children throughout the world: the need for a global registry

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