NDLI: End‐Stage Renal Care in Developing Countries: The India Experience

Content Provider	Taylor & Francis Online
Author	Jha, Vivekanand
Abstract	Chronic renal failure is a devastating medical, social and economic problem for patients and their families. There is no data on the true incidence and prevalence of chronic renal failure in the developing world. Delayed diagnosis and failure of institution of measures to slow progression of renal failure result in a predominantly young ESRD population. Renal replacement therapy (RRT) is a low‐priority area for healthcare planners in developing nations with two‐tier healthcare delivery system. There is a severe shortage of nephrologists and hospitals offering dialysis and transplantation, more so in the poorest regions. There is a direct relationship between the number of dialysis centers and per capita gross national income of developing nations. Shortage in the number of government‐funded hospitals has fanned the growth of a large number of private hospitals offering RRT. The high cost of hemodialysis (HD) puts it beyond the reach of all but the very rich and maintenance HD is the exclusively preserve of private hospitals. Government‐run hospitals are busy with renal transplantation, which is the only realistic long term RRT option for a majority of patients. There are no state‐funded or private health insurance schemes and patients have to raise finances for RRT on their own. Entire families are involved in such endeavors, with resulting loss of income of other family members too. A number of measures are utilized to bring down the RRT costs. For HD, these include cutting down the frequency of dialysis, use of cheaper cellulosic dialyzers, dialyzer reuse and nonutilization of expensive drugs like erythropoietin. Paradoxically, chronic peritoneal dialysis is more expensive than HD; patients use outdated connection systems and are suboptimally dialyzed on 3 exchanges/day. Most patients on dialysis are inadequately rehabilitated. Renal transplant recipients are forced to discontinue expensive drugs like cyclosporine after variable periods leading to high rates of graft loss. Financial considerations often preclude appropriate treatment of steroid‐resistant rejection and cytomegalovirus infection. There is no organized cadaver donation program and an overwhelming majority of transplants are performed using living donors. This led to the practice of the sale of kidneys for transplant. To conclude, the financial burden of RRT in developing nations impacts on the lifestyle and future of entire families, and extracts a cost far higher than the actual amount of money spent on treatment.
Starting Page	201
Ending Page	208
Page Count	8
File Format	PDF HTM / HTML
ISSN	0886022X 15256049
DOI	10.1081/JDI-120039516
Journal	Renal Failure
Volume Number	26
Issue Number	3
Language	English
Publisher	Taylor & Francis
Publisher Date	2009-07-07
Access Restriction	Open
Subject Keyword	Chronic kidney failure Healthcare costs Developing countries Hemodialysis
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine Nephrology

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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