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Hemodialysis versus peritoneal dialysis in resource-limited settings


Niang, Abdou; Iyengar, Arpana; Luyckx, Valerie A (2018). Hemodialysis versus peritoneal dialysis in resource-limited settings. Current Opinion in Nephrology and Hypertension, 27(6):463-471.

Abstract

PURPOSE OF REVIEW To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings.
RECENT FINDINGS Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally.
SUMMARY Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.

Abstract

PURPOSE OF REVIEW To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings.
RECENT FINDINGS Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally.
SUMMARY Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:November 2018
Deposited On:21 Feb 2019 11:53
Last Modified:21 Feb 2019 11:56
Publisher:Lippincott Williams & Wilkins
ISSN:1062-4821
OA Status:Closed
Publisher DOI:https://doi.org/10.1097/MNH.0000000000000455
Official URL:https://insights.ovid.com/pubmed?pmid=30148722
PubMed ID:30148722

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Embargo till: 2019-11-01