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Pediatric kidney replacement therapies in low-to-middle income countries: a review and white paper
Rajiv Sinha1, Lydia Noh2, Sidharth Kumar Sethi3
1Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India.
Insights
Pediatric kidney disease, including acute kidney injury (AKI) and chronic kidney disease (CKD), is a major concern in low- and middle-income countries (LMICs). Limited resources and healthcare access lead to higher mortality rates, necessitating targeted strategies and global collaboration.
Area of Science:
- Pediatric Nephrology
- Global Health Equity
- Renal Medicine in LMICs
Background:
- Acute kidney injury (AKI) and chronic kidney disease (CKD) disproportionately affect children in low- and middle-income countries (LMICs), with up to 85% of AKI cases occurring in these regions.
- Significant disparities in pediatric kidney disease outcomes exist due to limited access to kidney replacement therapy (KRT), diagnostic resources, healthcare providers, and financial barriers.
- Undiagnosed advanced stages of CKD and community-acquired AKI from preventable causes like infections and dehydration, coupled with nephrotoxic remedies, contribute to higher mortality rates in LMICs compared to high-income countries.
Purpose of the Study:
- To highlight global inequities in pediatric nephrology care.
- To propose targeted strategies for enhancing diagnostics, treatment, and management of AKI and CKD in LMICs.
- To issue a call for international collaboration and prioritization of resource-limited regions.
Main Methods:
- Review of existing literature and data on pediatric kidney disease in LMICs.
- Analysis of barriers to diagnosis and treatment, including KRT, laboratory and imaging resources, and healthcare provider shortages.
- Identification of successful international collaborations and potential strategies for improvement, such as peritoneal dialysis (PD) programs and innovative diagnostics.
Main Results:
- Pediatric kidney disease in LMICs is often diagnosed late, leading to poorer outcomes and higher mortality.
- Barriers such as socioeconomic inequalities, geographic challenges, and cultural factors exacerbate the problem.
- International collaborations and resource-efficient approaches like PD show promise in improving access and outcomes.
Conclusions:
- Urgent action is needed to address global inequities in pediatric nephrology care.
- Implementing affordable, resource-efficient programs, enhancing healthcare worker training, and adopting innovative technologies are crucial.
- Sustainable government policies, resource allocation, and community-based approaches, alongside international collaboration, are essential for improving care for children with kidney disease in LMICs.
Abstract:
Acute kidney injury (AKI) disproportionately impacts children in low- and middle-income countries (LMICs), where up to 85% of AKI cases occur. As for pediatric chronic kidney disease (CKD), the true burden in LMICs remains unclear, as many cases go undiagnosed early, and other children succumb without adequate treatment. Unfortunately, these disparities result from limited access to kidney replacement therapy (KRT), kidney laboratory and imaging resources, healthcare provider shortages, and financial barriers. Pediatric kidney disease in LMICs often remains undiagnosed until advanced stages, magnified by limited access to lifesaving KRT, leading to significantly higher mortality rates compared to high-income countries. Additional challenges include community-acquired AKI from preventable causes such as infections and dehydration, compounded by the use of nephrotoxic remedies, poor healthcare seeking behavior, and lack of monitoring. Pediatric data for this vulnerable population is lacking. For children with CKD, barriers to sustained treatment-including dialysis and transplantation-further worsen outcomes. Socioeconomic inequalities, geographic barriers, and cultural factors additionally exacerbate outcomes. Efforts to address these disparities include implementing affordable, resource-efficient peritoneal dialysis (PD) programs, enhancing healthcare worker training, and adopting innovative diagnostic technologies. Successful international collaborations, such as the Sister Renal Program, Saving Young Lives, and the Affordable Dialysis Project, have demonstrated the potential for improving access and outcomes. Advocacy for sustainable government policies, resource allocation, and integration of community-based approaches is critical. This paper highlights global inequities in pediatric nephrology care and proposes targeted strategies to enhance diagnostics, treatment, and management of AKI and CKD in LMICs. A call to action is issued to foster international collaboration and prioritize the needs of resource-limited regions.
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