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The management of end-stage renal disease in underdeveloped countries: a moral and an economic problem
1Hospital Luis Calvo Mackenna and Clinica Las Condes, Santiago, Chile.
Insights
Providing pediatric end-stage renal failure care in developing nations is challenging due to workforce shortages and limited resources. Early detection and treatment programs are crucial for preventing kidney failure progression.
Area of Science:
- Pediatric Nephrology
- Global Health
- Renal Replacement Therapy
Background:
- Significant challenges exist in delivering care for children with end-stage renal failure in underdeveloped countries.
- Shortages of essential healthcare professionals like dietitians, social workers, and physicians hinder comprehensive care due to low compensation and competing demands.
- Limited resources and socio-economic factors restrict the development of specialized pediatric kidney failure centers and advanced treatment modalities.
Purpose of the Study:
- To highlight the difficulties in providing pediatric end-stage renal failure care in developing countries.
- To discuss the limitations of current treatment options, including dialysis and transplantation, in resource-limited settings.
- To advocate for the development of structured treatment programs and population-based screening for renal diseases.
Main Methods:
- Review of challenges in pediatric end-stage renal failure care in underdeveloped countries.
- Analysis of the impact of socio-economic factors on treatment availability and delivery.
- Examination of the feasibility and outcomes of available renal replacement therapies.
Main Results:
- Comprehensive pediatric kidney failure centers are not feasible in many underdeveloped countries.
- Continuous ambulatory peritoneal dialysis is limited by socio-economic and hygienic conditions, though intermittent dialysis is provided.
- Kidney transplantation is restricted by a shortage of cadaver kidneys, but successful transplants have occurred in children on chronic peritoneal dialysis.
Conclusions:
- Underdeveloped countries need clear treatment programs for chronic renal failure in children.
- Initiating population-based screening for renal diseases is essential for early detection and prevention of progression.
- Integrated strategies are required to improve pediatric renal care in resource-limited settings.
Abstract:
There are major problems in providing care for children with end-stage renal failure in underdeveloped countries. It is difficult to employ key workers such as dietitians and social workers because of low pay and other demands for their services. The poor pay of physicians is also a problem and few can afford to devote the time necessary to care adequately for chronically disabled children. In Chile it has not been possible to develop comprehensive kidney failure centres for children. Continuous ambulatory peritoneal dialysis has not been encouraged due to the socio-economic and hygienic conditions of the population but isolated intermittent dialysis has been provided. Transplantation has been restricted due to the shortage of cadaver kidneys but a number of children maintained on hospital intermittent chronic peritoneal dialysis have been transplanted successfully. We believe that underdeveloped countries should develop clear programmes for the treatment of chronic renal failure and in addition initiate screening for renal diseases in the population so that early detection of renal disease, for instance in relation to urinary tract infection, can prevent progression to renal failure.