Options of renal replacement therapy in CKDu

Abstract

Patients with advanced Chronic Kidney Disease of Unknown origin (CKDu) need to plan for renal replacement therapy. The patients usually affected are probably best served with living-related renal transplantation. Potential donors from the same area are possibly at risk for developing CKDu and need close monitoring post kidney donation. Peritoneal dialysis (PD) is probably a better option as hemodialysis (HD) centers are located in urban areas only and patients have the convenience of receiving therapy at home. The “PD first” pilot project of Sri Lanka is a unique initiative that trains community physicians to offer PD to patients with advanced CKDu. In Telengana and Andhra Pradesh, the Aarogyasri insurance scheme provides for poor patients to avail of free HD and transplantation in government and private hospitals. Much more needs to be done to care for all those who are affected. A public–private partnership model for providing comprehensive care to patients with advanced CKDu can be undertaken in all areas affected by CKDu that makes renal replacement therapy (RRT) available and accessible, irrespective of financial and social limitations.

‘A disease of disparity’: chronic kidney disease of unknown aetiology in endemic immigrant communities

“…As the nature of CKD of unknown aetiology tends to be prevalent in rural parts of the world, this creates issues with access to haemodialysis centres often making peritoneal dialysis the preferred modality. 14 Transplantation would be ideal in an otherwise young population group; however, the risk of recurrence of CKD of unknown aetiology post-transplantation remains unknown, especially if underlying environmental tubular insults remain present. In an Aboriginal Australian population group, we see similar issues of both difficulty accessing dialysis but also lack of access to transplantation, with registry analysis showing Aboriginal Australian young adults having transplantation rates of only 56.2% compared with 89.3% in a non-Aboriginal equivalent group.…”

“…As the nature of CKD of unknown aetiology tends to be prevalent in rural parts of the world, this creates issues with access to haemodialysis centres often making peritoneal dialysis the preferred modality 14 . Transplantation would be ideal in an otherwise young population group; however, the risk of recurrence of CKD of unknown aetiology post‐transplantation remains unknown, especially if underlying environmental tubular insults remain present.…”

CaPO4-Mediated CKD of Crystallo-Tubular-Nephropathy [CKD-CTN]—A Crystal and Nanotube-Induced Geo-Environmental Disease

“…Since CKD-CTN is closely related to the environment where the affected people live for decades and consume natural groundwater, lifestyles, drinking water, and dietary habits must address systematically to overcome the adverse effects on the kidney and other vital organs. Providing financial assistance, renal protective medications (i.e., renal replacement therapy) (Varughese et al, 2020), and dialysis would never prevent the CKD-CTN. Governments of the affected countries must focus on disease prevention: the right approach and solutions based on the mentioned root cause to eradicate CKD-CTN (Wimalawansm, 2015).…”

Chronic Kidney Disease of Unknown Origin: Think Beyond Common Etiologies

“…An innovative program in Sri Lanka called "PD First" teaches neighborhood doctors to provide PD to clients with late CKDu. The Aarogyasri insurance program in Telangana and Andhra Pradesh enables underprivileged clients to receive free hemodialysis and transplantation in public and corporate institutions [ 32 ].…”