Abstract
Kidney disease is increasingly being recognized as a public health problem, not only because large numbers of patients are affected, but also because of the diagnostic and therapeutic challenges associated with its management, especially in low resource settings, where conflicts between financing, equity and social values frequently arise. When kidneys fail, either acutely or chronically, dialysis represents an immediate life-saving therapy. Dialysis is technically available in most countries, but is time, labor and resource intensive, which limits access largely to those who can afford to pay when not covered through universal health coverage or health insurance. Access to dialysis is therefore highly inequitable across country income groups globally and within countries. Dialysis poses ethical challenges at many levels in low-resource settings. Policy makers must consider whether to provide dialysis at all or leave it to market forces. If dialysis is to be provided, who, where and how to dialyze safely and equitably are necessary questions to consider. When these questions are not addressed transparently at a policy level, clinicians and families must face complex decisions about whether to start dialysis or not at the bedside.
Policy-making requires evidence. Based on broad inequities in access to dialysis and the potential consequences for individuals and families, health care workers, the health system and society, this PhD begins with an epidemiologic description of outcomes in patients requiring dialysis in sub-Saharan Africa and consequent moral distress experienced by nephrologists at the bedside, investigates overarching strategies to reduce the global burden of kidney disease, and focuses on the ethical implications of priority setting and policy making regarding provision of dialysis in sub-Saharan Africa.
Luyckx, Valerie Ann