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Mazhar, Farida; Nizam, Naveeda; Fatima, Nazia; Siraj, Sana; Rizvi, Syed Adibul Hasan

doi:10.6002/ect.mesot2016.o27

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…A major problem is that 20%–80% of the population resides in rural areas, while dialysis centers are located in urban centers [ 2 , 3 ]. In our experience, although dialysis is free, patients have poor dialytic compliance due to long-distance and travel costs [ 13 ]. Establishment of satellite centers nearer to the doorstep of the patients have helped 1,875 patients access dialysis near their area of residence with substantial savings in time and travel costs.…”

Section: Discussionmentioning

confidence: 99%

Providing “Free” Access to Dialysis and Transplant to the Disfranchised. A Sustainable Model for Low and Low Middle Income Countries (LMICs)

Zafar¹,

Rizvi²

2023

Transpl Int

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Pakistan is a low-middle income country where incidence of End Stage Kidney Disease (ESKD) is 100–150 per million population (pmp). Paucity and high costs of renal replacement therapy (RRT) renders the majority disfranchised, since the dialysis rate is 15 pmp and the transplant rate is 4–5 pmp. In view of this, our center started an integrated dialysis and transplant program where all treatment is provided “Free of Cost” to all patients, with lifelong follow-up and medications. The model is based on the concept of community-government partnership funded by both partners. The annual contribution in 2021 was $37.4 million. >1,500 patients were dialyzed daily, and 6–8 received transplants weekly. Of the 6,553 transplants performed between 1985–2021, 988 (15%) were children. Overall, the 1 and 5-year graft survival rate was 97% and 88%. The donor clinic has 3,786 donors in regular yearly follow-up for up to 30–35 years where ESKD prevalence is 0.29%. Access to dialysis was increased by establishing six satellite centers reducing patient time and travel costs. Cost reductions by dialyzer reuse and generic drugs resulted in an annual saving of $5.8 m. This sustainable model has overcome the inherent socio-economic, logistic, cultural, and gender biases in RRT in LMICs. It has provided RRT with equity to the disfranchised in Pakistan and can be replicated in other LMICs with community-government support.

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Section: Discussionmentioning

confidence: 99%

Providing “Free” Access to Dialysis and Transplant to the Disfranchised. A Sustainable Model for Low and Low Middle Income Countries (LMICs)

Zafar¹,

Rizvi²

2023

Transpl Int

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“…Additionally, all government employees are offered free RRT and medications. In Pakistan, charity institutions such as Sindh Institute of Urology and Transplantation run the busiest dialysis centers with 350 HD machines and over 1000 dialysis sessions/day [ 21 ]. Inevitably, LE countries have serious disparities in delivery of care to the populations living in remote areas.…”

Section: Discussionmentioning

confidence: 99%

Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia

Schmeißer

Jasuja

Gallieni

et al. 2021

International Journal of Nephrology

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Background. The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods. Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results. Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). “On-demand” hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%–20% in the majority of LE countries. Conclusion. Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.

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“…Thus, schemes to increase coverage for these services should be coupled with efforts to improve access to facilities in rural and remote locations. 21 , 22 …”

Section: Opportunities For Improvements and Expansionmentioning

confidence: 99%