End-stage renal disease in Indonesia: treatment development

The number of cases of chronic kidney disease is growing rapidly, especially in the developing world. At a certain level of renal function, progression of chronic kidney disease to endstage renal disease (ESRD) is inevitable. ESRD has become a major health problem because it is a devastating medical condition, and the cost of treatment is a huge economic burden. This article presents data collected from 13 nephrology centers in response to specifically designed questionnaires. These centers were divided into 7 groups on the basis of geographic location. Previous data had given the impression that the incidence and prevalence of ESRD had increased, and the results of this study support these previous data. Since a national registry of ESRD has just been developed for Indonesia and we can present only limited data in this study, the numbers in this article underestimate the true incidence and prevalence rates. Although hemodialysis facilities have been developed rapidly, further development is still required. Continuous ambulatory peritoneal dialysis as an alternative renal replacement therapy (RRT) is only now being introduced. Kidney transplantation programs expand very slowly. RRT still imposes a high cost of treatment for ESRD; therefore, these treatments are unaffordable for most patients. Recently, government health insurance has covered financially strained families requiring RRT. Since the cost of RRT for ESRD has significantly increased over time, the management approach should be shifted from treatment to prevention.