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Challenges of access to kidney care for children in low-resource settings
Mignon McCulloch1, Valerie A Luyckx2,3,4, Brett Cullis4,5
1Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa. mignon.mcculloch@uct.ac.za.
Insights
Kidney disease in children is a global concern, especially in low-resource areas lacking diagnosis and treatment access. Acute peritoneal dialysis (PD) offers a low-cost solution, with programs saving hundreds of children with acute kidney injury (AKI).
Area of Science:
- Pediatric Nephrology
- Global Health
- Public Health
Background:
- Kidney disease, including chronic kidney disease (CKD) and acute kidney injury (AKI), is a significant global health issue affecting all age groups, particularly children.
- Low-resource settings face substantial challenges in managing kidney disease due to limited awareness, diagnostic capabilities, and access to advanced treatments like dialysis and transplantation.
- Children in resource-limited areas are especially vulnerable to AKI from preventable causes, often succumbing to potentially reversible conditions due to inadequate healthcare access.
Purpose of the Study:
- To highlight the challenges and impact of kidney disease in children within low-resource settings.
- To emphasize the critical role of accessible and low-cost treatment options like acute peritoneal dialysis (PD) for AKI.
- To advocate for capacity building, education, and increased awareness for improved diagnosis and management of pediatric kidney diseases globally.
Main Methods:
- Review of the global burden of kidney disease in children, focusing on low-resource contexts.
- Analysis of the effectiveness of acute peritoneal dialysis (PD) as a low-cost intervention for AKI.
- Examination of successful initiatives like the Saving Young Lives programme in training local healthcare professionals.
Main Results:
- Acute peritoneal dialysis (PD) has proven to be an effective and low-cost treatment for acute kidney injury (AKI) in children.
- Initiatives focused on training local medical staff in low-resource areas have successfully treated hundreds of children with AKI, demonstrating the impact of targeted capacity building.
- There is a clear need for enhanced local knowledge, confidence, and resources for managing both AKI and CKD in pediatric populations.
Conclusions:
- Acute peritoneal dialysis (PD) is a vital, cost-effective intervention for pediatric acute kidney injury (AKI) in resource-limited environments.
- Capacity building, education, and resource provision are crucial for improving AKI and CKD management in children globally.
- Increased local and international advocacy is essential to improve the diagnosis and treatment of kidney diseases in children worldwide.
Abstract:
Kidney disease is a global public health concern across the age spectrum, including in children. However, our understanding of the true burden of kidney disease in low-resource areas is often hampered by a lack of disease awareness and access to diagnosis. Chronic kidney disease (CKD) in low-resource settings poses multiple challenges, including late diagnosis, the need for ongoing access to care and the frequent unavailability of costly therapies such as dialysis and transplantation. Moreover, children in such settings are at particular risk of acute kidney injury (AKI) owing to preventable and/or reversible causes - many children likely die from potentially reversible kidney disease because they lack access to appropriate care. Acute peritoneal dialysis (PD) is an important low-cost treatment option. Initiatives, such as the Saving Young Lives programme, to train local medical staff from low-resource areas to provide care for AKI, including acute PD, have already saved hundreds of children. Future priorities include capacity building for both educational purposes and to provide further resources for AKI management. As local knowledge and confidence increase, CKD management strategies should also develop. Increased awareness and advocacy at both the local government and international levels will be required to continue to improve the diagnosis and treatment of AKI and CKD in children worldwide.
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