New estimates indicate that at best only half of people worldwide needing kidney dialysis or transplantation to treat kidney failure in 2010 received it. This suggests that at least 2.3m people may have died prematurely from kidney failure because they could not access this life-saving treatment, reports Science Newsline.
The research shows that most of these preventable deaths occurred in China, India, Indonesia, Pakistan, and Nigeria, where less than a quarter of eligible patients receive treatment for kidney failure. "The high cost of current dialysis techniques ($20.000-$100.000 per person each year) are unaffordable to most people who need it," says lead author Professor Vlado Perkovic of The George Institute for Global Health and The University of Sydney, Australia.
"With the number of people receiving dialysis or kidney transplantation set to more than double to over 5m by 2030 there is a dire need for low-cost dialysis techniques, as well as population-wide prevention programmes to tackle the key risk factors for end-stage kidney disease including diabetes, high blood pressure, and obesity."
Perkovic and colleagues systematically reviewed observational studies, renal registries, and contacted national experts to collect data on the actual numbers of patients receiving renal replacement therapy (RRT; dialysis and kidney transplantation) in 123 countries, representing 93% of the world population. They used mathematical modelling to develop both upper and lower estimates of the likely need for RRT in each country, and projected needs to 2030. The findings show that 2.62mpeople were actually treated with RRT in 2010, with 78% of them given dialysis. Most (92.8%) of those treated in 2010 lived in high- or high-middle income countries, and just 7.2% in low- and low-middle income countries.
However, the authors calculated that worldwide the number of patients needing RRT in 2010 were 4.9m in a conservative model (in which RTT was only partly implemented) and 9.7m if RRT access were high in all countries. "These scenarios suggest that between 2.3m and 7.1m individuals who could have been kept alive with RRT in 2010 died prematurely because treatment was unavailable," explains Perkovic.
The authors also forecast that the number of people receiving RRT will more than double to 5.4m by 2030, mostly in developing regions such as Asia (from 0.968m in 2010 to 2.162m by 2030) and Africa (from 0.083m to 0.236m).
According to Perkovic, "Quantifying the burden of end-stage kidney disease is vital because without good numbers there can be no targets for improvement or evidence for industry to invest in developing new low-cost technologies for RRT. The large number of deaths occurring because of poor access to treatment sets a demanding task for the nephrology community and the health-care and research communities in general."
In South Africa, only about a third of those living with kidney conditions are receiving life-saving dialysis, Professor Sarala Naicker, president of the South African Renal Society said in a Health-e report. It is estimated that about 18,000 South Africans could be in need of dialysis and while the burden of kidney disease has increased, the number of dialysis machines in South Africa has not.
With long journeys to and from hospital and the hours spent attached to the dialysis machine, treatment can become an all-day affair. This makes holding down a regular job near impossible, the report says.
Dialysis machines can be purchased for about R200,000, but the actual treatment is very costly. It costs the state about R120,000 per year for each patient receiving haemodialysis treatment. Public hospitals throughout the country are frequently turning desperately ill patients away, Naicker added.
"In the last two years, our waiting list crisis has become acute," she explained. "A fair number of patients, by the time we can make a slot for them, they’re no longer alive and that’s a very sad situation." said Naicker. Public hospitals will also only take in patients for dialysis who are eligible for a kidney transplant, but there is a lack of donors. "It's actually been a very difficult situation for the doctors and nurses on the ground because there are lots of patients who do fulfill the criteria for straight treatment but are unable to have it," Naicker said.
Naicker and other kidney doctors have suggested that smaller satellite treatment centres be established to make dialysis more accessible. "In the short term, we do need to have increase in our dialysis facilities so that we are able to offer more treatment to people already in kidney failure," she said. "We need many more units in many more places."
[link url="http://www.sciencenewsline.com/articles/2015031321150051.html"]Full Science Newsline report[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60126-X/abstract"]The Lancet article summary[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60269-0/abstract"]The Lancet editorial summary[/link]
[link url="http://www.health-e.org.za/2015/03/12/thousands-may-die-without-life-saving-dialysis/"]Full Health-e report[/link]