Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia

Suceena Alexander 1, Sanjiv Jasuja 2, Maurizio Gallieni 3, Manisha Sahay 4, Devender S Rana 5, Vivekanand Jha 6, Shalini Verma 7, Raja Ramachandran 8, Vinant Bhargava 5, Gaurav Sagar 2, Anupam Bahl 2, Mamun Mostafi 9, Jayakrishnan K Pisharam 10, Sydney C W Tang 11, Chakko Jacob 12, Atma Gunawan 13, Goh B Leong 14, Khin T Thwin 15, Rajendra K Agrawal 16, Kriengsak Vareesangthip 17, Roberto Tanchanco 18, Lina H L Choong 19, Chula Herath 20, Chih C Lin 21, Nguyen T Cuong 22, Ha P Haian 23, Syed F Akhtar 24, Ali Alsahow 25, Mohan M Rajapurkar 26, Vijay Kher 27, Hemant Mehta 28, Anil K Bhalla 5, Umesh B Khanna 29, Deepak S Ray 30, Sonika Puri 31, Himanshu Jain 7, Aida Lydia 32, Tushar Vachharajani 33

Affiliations

05 June 2021

-

doi: 10.1155/2021/6665901

Abstract

Background: The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA).

Methods: Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care.

Results: Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). "On-demand" hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%-20% in the majority of LE countries.

Conclusion: Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1 Schematic description of data collection.

Figure 1 Schematic description of data collection.

Figure 2 South Asia and Southeast Asia regional depiction based on economy.

Figure 2 South Asia and Southeast Asia regional depiction based on economy.

Figure 3 Impact of GDP on funding source, treatment adequacy, and yearly dropout.

Figure 3 Impact of GDP on funding source, treatment adequacy, and yearly dropout.

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