The role of the Kidney Foundation of Bangladesh in promoting kidney care in a resource-limited environment

Rashid, Harun Ur; Arefin, Sakibuzzaman; Hasan, Sazid; Alam, Khurshidul

doi:10.5414/cnp86s106

Cited by 8 publications

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“…[9] However, ESRD management in low middle income countries is too expensive to meet the burden of treatment, such as, a study reported that 80% of kidney-failure patients could not afford treatment prior to 2003. 10 In addition, in Southeast Asia, renal replacement therapy (RRT) or dialysis costs are more than 10 times the annual per capita income of approximately USD 400, and health insurance coverage is low or non-existent for RRT/ CKD treatment. 11 CKD-associated mineral and bone disorders (also termed as metabolic bone disease, MBD) or CKD-MBD is one of the common complications, appeared with progression of CKD comprising the abnormalities in mineral and bone metabolism having both skeletal and extra skeletal consequences.…”

Section: Introductionmentioning

confidence: 99%

Level of Serum Parathyroid, Calcium, Phosphate and Vitamin D and Their Correlation In Occurrence of Mineral Bone Disorder In Ckd Patient Admitted in Adult Medicine Ward Of a Tertiary Hospital in Bangladesh

et al. 2022

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Background: Chronic kidney disease (CKD) is a global health problem associated with increased risks of morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until progressive damage occurs and produce multiple symptoms and signs. Progressive loss of kidney function in CKD leads to reduced production of 1-á-(OH) 2-D3 (1, 25-dihydroxyvitamin D; calcitriol) and abnormal mineral homeostasis. The aim of the study was planned to assess the mineral and bone disorder in CKD patients admitted in a tertiary care hospital. Methods: A Cross sectional observational study was performed at a tertiary care centre. 100 cases of diagnosed Chronic Kidney Disease patients in indoor of department of Nephrology and Medicine of Sir Salimullah Medical College Mitford hospital from March 2018 to August 2018 were included in this study. Results: Majority of the patients (60%) were of age between 46 and 65 years. 31% of the study population were older than 65 years. 72% of the study population were male and 28% were female. Diabetic nephropathy was the leading cause of CKD, affecting 36% of the study population. Hypertension was the likely cause in 26% of the subjects. Obstructive uropathy and chronic glomerulonephritis affected 7% and 5% of the subjects respectively. There was one (1%) patient with ADPKD, and in 25% of the cases no causative factor was identified. Most (40%) of the study subjects were in the stage 3 of CKD. 34% & 26% of the patients were in the stage 5 & 4 respectively. We did not find any patient with normal vitamin D level. 10% of the patients were in the insufficient range and 90% of the study subjects were deficient in vitamin D. Hyperparathyroidism was prevalent in 75% of the study subjects. 79% of the patients had elevated serum phosphate levels. Hypocalcemia was found in 49% of the patients. 33% of the patients had hyperkalemia during admission. Hyperphosphatasia was prevalent in 39% of the study subjects. However, bone fraction of the ALP was not tested. Among stages 3B, 4 and 5 CKD patients, there were 2% patients in each group that were insufficient in vitamin D. Majority (32% in stage 5, 24% each in stages 3B and 4) were deficient in vitamin D. Deficiency was also prevalent in earlier stages of CKD (10% patients in stage 3A). The difference was statistically significant, that is, the later the stage of CKD the greater the prevalence of vitamin D deficiency was. All the patients in stage 5 and 4 (34% and 26% respectively) had hyperparathyroidism. 0% and 15% of the patients in stages 3A and 3B respectively had hyperparathyroidism. The difference between groups was statistically significant. Serum calcium level correlated well with the stage of CKD. Most of the patients in stage 5 were hypocalcemic (32 among 34). Among the 39% of the total study population with hyperphosphatasia, 24%, 9% and 6% were in stages 5, 4 & 3B respectively. Which were statistically significant. 49% pf the patients had hyperparathyroidism with hypocalcemia, 26% of the patients had hyperparathyroidism and normal serum calcium levels. None of the patients had hypocalcemia and normal PTH level. Among the 90 patients with deficient vitamin D levels, 46 had hypocalcemia also. 70 patients with deficient vitamin D level also had high PTH level. The difference between groups which was statistically significant. Conclusion: MBD is a common complication in our CKD patients. Raised PTH, low 25(OH) D, and raised phosphorus levels were the most prevalent markers. Majority of our patients presented, or were referred late. Clinical features of MBD in CKD were poor guides to the presence of MBD in our pre-dialysis patients. Bangladesh J Medicine 2022; 33: 145-153

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Section: Introductionmentioning

confidence: 99%

Level of Serum Parathyroid, Calcium, Phosphate and Vitamin D and Their Correlation In Occurrence of Mineral Bone Disorder In Ckd Patient Admitted in Adult Medicine Ward Of a Tertiary Hospital in Bangladesh

et al. 2022

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“…The term “on-demand” refers to availing dialysis only when the patient is severely symptomatic or when the patient has amount to pay or rationing the funds for long-term. Variable cost of HD within LE countries is documented in the literature, lower in India [ 10 , 27 ], Bangladesh [ 10 ], and at charitable or government sponsored centers in Pakistan (0–18 US$) [ 23 , 28 ], but higher in Bangladesh's private setup (44–62 US$) [ 15 , 29 ]. Most of the non-profitable institutions in Vietnam [ 30 ] and Myanmar [ 12 ] charge 25 US$ and 40 US$, respectively whereas in Nepal the state reimburses of 22 USD per HD session [ 31 ].…”

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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“…1,5,.7 and hypertension are the main causes of ESKF in HD patients. 8 Most dialysis centers in Bangladesh operate for profit, with costs ranging from US $44-62 per session, compared with nonprofit hospitals, which charge US $12-18. 1 Limited availability of funds has resulted in the discontinuation of the scheduled dialysis program in government health care institutions in Bangladesh, which previously provided subsidized dialysis at four USD per session for eligible patients selected by a committee.…”

Section: Bangladesh Perspective Of Kidney Disease Managementmentioning

confidence: 99%

Global Dialysis Perspective: Bangladesh

Kar,

Islam

2023

Kidney360

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The role of the Kidney Foundation of Bangladesh in promoting kidney care in a resource-limited environment

Abstract: KFB is offering treatment for patients with kidney disease and kidney failure, not only at an affordable price, but also without compromising quality.

Cited by 8 publications

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Level of Serum Parathyroid, Calcium, Phosphate and Vitamin D and Their Correlation In Occurrence of Mineral Bone Disorder In Ckd Patient Admitted in Adult Medicine Ward Of a Tertiary Hospital in Bangladesh

Level of Serum Parathyroid, Calcium, Phosphate and Vitamin D and Their Correlation In Occurrence of Mineral Bone Disorder In Ckd Patient Admitted in Adult Medicine Ward Of a Tertiary Hospital in Bangladesh

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

Global Dialysis Perspective: Bangladesh

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