Paediatric nephrology in under-resourced areas

Banerjee, Sushmita; Kamath, Nivedita; Antwi, Sampson; Bonilla–Félix, Melvin

doi:10.1007/s00467-021-05059-y

Cited by 18 publications

(15 citation statements)

References 81 publications

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“…In high income countries (HIC) pediatric dialysis is easily accessible and financially supported by the government. While over 50% of the world's children live in LMICs, maintenance dialysis for children is virtually non-existent in Sub-Saharan Africa ( 21 ) and very limited in India and other regions ( 23 , 34 ). In LMICs there is inadequate maintenance dialysis infrastructure and insufficient numbers of pediatric nephrologists for the population served ( 35 ).…”

Section: Inequity In Access To Dialysismentioning

confidence: 99%

“…In the private sector, where the majority of pediatric dialysis occurs, treatments are expensive, with high out-of-pocket (OOP) costs to families resulting in catastrophic healthcare expenditure ( 40 , 41 ). Further, utilization of dialysis is impacted by need for travel to access care ( 23 , 42 ). Treatment non-adherence is common and dialysis is commonly discontinued resulting in high rates of patient death or loss to follow up ( 29 , 43 – 45 ).…”

Section: Inequity In Access To Dialysismentioning

confidence: 99%

“…Similar data from LMICs is very limited due to the lack of registries, and is usually based on single center studies. In South-East Asia and Sub-Saharan Africa where maintenance dialysis is not available to the majority, the reported incidence of pediatric kidney failure is very low (< 10 pmarp) (1,(21)(22)(23).…”

Section: Disparities In Kidney Failure Between Hic and Lmicsmentioning

confidence: 99%

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Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

Pais

Wightman

2022

Front. Pediatr.

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Children with kidney failure require kidney replacement therapy (KRT), namely maintenance dialysis and kidney transplant. Adequate kidney failure care consists of KRT or conservative treatment with palliative care. In the context of kidney failure, children depend on parents who are their surrogate decision-makers, and the pediatric nephrology team for taking decisions about KRT or conservative care. In this paper, we discuss the ethical challenges that arise relating to such decision-making, from a global perspective, using the framework of pediatric bioethics. While many ethical dilemmas in the care of children with KRT are universal, the most significant ethical dilemma is the inequitable access to KRT in low & middle income countries (LMICs) where rates of morbidity and mortality depend on the family's ability to pay. Children with kidney failure in LMICs have inadequate access to maintenance dialysis, timely kidney transplant and palliative care compared to their counterparts in high income countries. Using case vignettes, we highlight how these disparities place severe burdens on caregivers, resulting in difficult decision-making, and lead to moral distress among pediatric nephrologists. We conclude with key action points to change this status-quo, the most important being advocacy by the global pediatric nephrology community for better access to affordable kidney failure care for children.

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Section: Inequity In Access To Dialysismentioning

confidence: 99%

Section: Inequity In Access To Dialysismentioning

confidence: 99%

Section: Disparities In Kidney Failure Between Hic and Lmicsmentioning

confidence: 99%

See 1 more Smart Citation

Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

Pais

Wightman

2022

Front. Pediatr.

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“…In addition to highlighting the ethical dilemmas encountered, the authors have generated important data about the true costs of "free" dialysis. This adds to the literature on catastrophic healthcare expenditure incurred during public sector dialysis that is [11] available for adult patients [8]. In the absence of a national registry, these single centre studies provide key information to spur advocacy efforts.…”

Section: Beneficence Versus Non-maleficencementioning

confidence: 96%

Key ethical challenges in providing dialysis in low resource settings — A view from the trenches

Pais¹,

Luyckx²

2023

IJME

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“…Although pediatric registries and cohorts using the K/DOQI or KDIGO classifications are emerging, only a small number of studies on the epidemiology of CKD stages 2-5 are available. Due to the lack of disease awareness, access to diagnosis, and data acquisition, the prevalence of kidney diseases in low-resource settings is even less well known [12]. For these countries, the data mainly come from reports of the main tertiary care centers and the true burden of pediatric CKD is widely underestimated or unrecognized.…”

Section: Current Evidence On Childhood Ckd Prevalence and Study By Ge...mentioning

confidence: 99%

What is the true burden of chronic kidney disease in children worldwide?

Harambat

Madden²

2022

Pediatr Nephrol

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Paediatric nephrology in under-resourced areas

Cited by 18 publications

References 81 publications

Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

Key ethical challenges in providing dialysis in low resource settings — A view from the trenches

What is the true burden of chronic kidney disease in children worldwide?

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