Abstract
Chronic Kidney Disease (CKD) remains a global health concern with far-reaching implications. Generally asymptomatic in the initial stages, CKD often goes undetected until it escalates into a more threatening condition, which could ultimately culminate in kidney failure. This narrative review undertakes a comprehensive examination of treatment options available for CKD in America, Africa, and Asia, with a specific focus on the associated costs weighing heavily upon healthcare systems. The study’s findings, drawn from institutions within these continents, starkly illuminate the economic burdens posed by CKD treatments.
Introduction
Chronic Kidney Disease (CKD) is a progressive illness characterized by the gradual loss of kidney function over time. It poses a significant health risk as it is linked to increased chances of heart and vascular diseases, and can lead to kidney failure requiring costly treatments like dialysis or a kidney transplant. A recent publication in the “Annales pharmaceutiques francaises” offers an eye-opening narrative overview of CKD treatment costs and options in America, Africa, and Asia (Mourchid Rania R. et al., 2024). According to the article, early detection and intervention can prevent the progression of CKD, yet across continents, the expense of managing the disease varies greatly and poses different challenges to healthcare systems.
The Prevalence and Impact of CKD
In the US, CKD affects an estimated 15% of the adult population, with a disproportionate impact on minority and low-income groups. In Africa, the prevalence is harder to assess due to a lack of comprehensive screening and underreporting, but it’s known to be exacerbated by factors such as hypertension, diabetes, and infectious diseases. Similarly, parts of Asia face high CKD prevalence stemming from both non-communicable and infectious diseases.
CKD can advance to end-stage renal disease (ESRD), at which point renal replacement therapy (RRT), namely dialysis or transplantation, becomes essential for survival. These treatments present a heavy financial burden on healthcare infrastructures, especially in low to middle-income countries.
Treatment Options and Costs
The main treatment modalities for CKD are hemodialysis, peritoneal dialysis, and kidney transplantation. Hemodialysis involves mechanically filtering waste from the blood, typically performed in a clinic three times a week. Peritoneal dialysis uses the lining of the abdomen to filter blood inside the body and can often be done at home. Kidney transplantation, while offering the best quality of life and cost advantages over time, comes with significant upfront costs and requires a compatible donor, which can be a limiting factor.
In America, the costs associated with these treatments can reach upwards of $89,000 per patient annually for dialysis, with transplantation costs varying widely based on donor type and hospital charges. Insurance plays a major role in ensuring accessibility to these treatments.
Comparatively, in Africa, the cost and limited availability of RRT make it an inaccessible option for many, with some countries reportedly having less than 5 dialysis machines per million people. The cost per dialysis session can range from $50 to $100, creating a substantial financial barrier.
Asia presents a contrasting scenario where treatment costs vary widely from country to country, but, especially in low to middle-income areas, they still remain largely prohibitive for the average citizen.
Global Disparities and Challenges
The disparities in CKD treatment accessibility and affordability are stark. In high-income countries, healthcare systems and insurance structures typically cover the high costs of treatment, allowing patients to receive adequate care. However, in low and middle-income countries, the majority of patients face the grim reality of inadequate access to treatments due to costs and other socioeconomic factors.
Conclusion
CKD treatment costs remain a considerable strain on healthcare systems across the globe. While treatment options are medically advanced and available, the financial implications form the largest barrier to accessibility, especially in developing regions. It is a call to action for global health initiatives to address these discrepancies and work towards equitable health solutions for CKD patients everywhere.
DOI and References
DOI: 10.1016/j.pharma.2024.01.002
1. Mourchid Rania R., et al. “Chronic kidney disease in America, Africa, And Asia: overview of treatment cost and options.” Annales pharmaceutiques francaises, vol. S0003-4509(24), no. 00002-6, 2024.
2. National Kidney Foundation. “Global Facts: About Kidney Disease,” https://www.kidney.org/news/newsroom/factsheets/Global-Facts-About-Kidney-Disease.
3. Liyanage, T., et al. “Worldwide access to treatment for end-stage kidney disease: a systematic review.” The Lancet, vol. 385, no. 9981, 2015, pp. 1975-1982.
4. Genovese, G., Friedman, D. J., & Pollak, M. R. “Apopolipoprotein L1 variants and kidney disease in people of recent African ancestry.” Nature Reviews Nephrology, vol. 8, 2012, pp. 256-265.
5. Jha, V., et al. “Chronic kidney disease: global dimension and perspectives.” The Lancet, vol. 382, no. 9888, 2013, pp. 260-272.
Keywords
1. Chronic Kidney Disease Treatment
2. CKD Treatment Costs
3. Dialysis Accessibility
4. Renal Replacement Therapy Affordability
5. Global Kidney Health Disparities
