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Review
. 2021 May 6:2021:6665901.
doi: 10.1155/2021/6665901. eCollection 2021.

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
Review

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

Suceena Alexander et al. Int J Nephrol. .

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic description of data collection.
Figure 2
Figure 2
South Asia and Southeast Asia regional depiction based on economy.
Figure 3
Figure 3
Impact of GDP on funding source, treatment adequacy, and yearly dropout.
See this image and copyright information in PMC

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