The baby was a 38-year-old mother of four with end-stage renal disease. She was vomiting, tired and she needed dialysis three times a week. But in her town in northern India, the cost of her treatment was prohibitive. Her daughters dropped out of school to save money, but her family still lagged behind the household budget. Baby could only pay for one dialysis treatment each week. Ultimately, even that was too costly. She stopped receiving treatment and died soon after.
Vivek Jha, nephrologist and executive director of the George Institute for Global Health in New Delhi, India, contrasts Baby’s story with that of another patient. Jha told the man that the best option for survival was a kidney transplant, but the father of two young children could not afford it. “We thought he was going to be one of those who would go home and die,” he says. Instead, some of my vendor colleagues asked Jha what he could do. The money they raised, combined with funding from a local philanthropist and a kidney donated by the man’s mother, allowed him to get the surgery he needed.
Part of Nature Outlook: Chronic Kidney Disease
Life expectancy for a patient with end-stage renal failure, also known as renal failure, is approximately 15 years for a kidney transplant (possibly longer or shorter depending on whether the kidney is from a living donor). there is). People on dialysis have an average life expectancy of 5 to 10 years. Those who receive neither will die within a month. Transplantation, dialysis, or death are the only options for people with kidney failure. Which of her three experiences a person experiences is largely determined by where they live, socioeconomic status, education, and race. For end-stage renal disease, the risk is high and the equity gap is acute.
Most countries lack organs from both living and deceased donors. Dialysis is therefore the most common option for patients with renal failure and is far from ideal. Peritoneal dialysis uses a catheter in the abdomen to passively infuse solutions over a period of at least 8 hours. It is usually performed overnight at home and requires storage space to store dozens of boxes of solutions for a month of treatment, as well as stable power supply, a sanitary area for treatment, and access to running water. is.
Another approach, hemodialysis, uses a machine to remove blood, filter it, and then reinfuse it with clean blood. This process requires the recipient to undergo surgery to create vascular access. This aggressive process can be done more quickly and less frequently than peritoneal dialysis (three times a week, about four hours at a time), but it is usually done in a dialysis center and can be exhausting for hours afterwards. You may. In countries with few social safety nets, such as the United States, these hours result in being away from work or losing wages, often forcing people to make difficult choices between physical and financial security. You can
the rich get healthier
Different wealth and health care systems mean that countries tend to take people with kidney failure down different paths. In low-income countries, the path is often conservative management. With few or no dialysis centers and exorbitant treatment costs, end-stage kidney disease is usually a near-death sentence. It has been shown that only 1 in 100 people with HIV will receive treatment.1Often they don’t realize they’re signing up for long-term contracts, says Jha. Depending on the location, going to free clinics may be too time consuming and expensive to maintain. Many people travel long distances thinking they are heading towards a one-time cure. “Once they get there, they realize there is no cure,” adds Jha. “They start dialysis but soon realize it’s not sustainable and they drop out and die.”
Kidney disease is the leading cause of ‘devastating health care costs’ in low- and lower-middle-income countries. This is when a household’s medical expenses exceed a certain threshold of ability to pay. Nearly all kidney disease patients with accessible and sustainable treatment live in high-income or upper-middle-income countries.2Despite having larger populations than high-income countries and some having similar or higher incidences of kidney disease, only about 7% of people on dialysis who receive regular treatment are low-income. live in a country or low-middle-income country. compared to other parts of the world.
Equity gaps persist, even in upper-middle and high-income countries. People with similar illnesses receive different treatments and meet different fates. This applies not only to a country’s health system (private insurance compared to universal coverage, or a focus on transplantation over dialysis), but also on a person’s place of residence, support networks, socioeconomic status, race, It can also depend on ethnicity. .
Adeera Levin, Executive Director of BC Renal in Vancouver, Canada, said: British She oversees care and assignments for Kidney Services in Columbia. “And with any illness, the more resources you have as an individual, be it financial, intellectual, or support services, the more likely you are to do well.”
“In British Columbia, for example, health care is free, but it’s geographically diverse,” says Levin, who is also a nephrologist at the University of British Columbia in Vancouver. “If he had to travel 100 miles to see a specialist, he wouldn’t get the same treatment as if he had to travel three blocks.”
The United States has a different set of equity issues. The main reason is that the U.S. private health care system means that uninsured people slip through the cracks. There is no universal coverage to prevent or slow progression. Only when someone is diagnosed with kidney failure will the government intervene and Medicare (a federal program for people over the age of 65 or with certain disabilities) will pay for dialysis 90 days after he starts treatment. increase.
But many people think this approach is like trying to put out a wildfire with a garden hose. Interventions that can slow the progression of kidney disease, such as regular exercise, a kidney-friendly diet, certain medications, and control of blood sugar and blood pressure, are most effective when started early in the course of the disease. Everything is done before you go on dialysis,” says Levin. In countries like Canada with universal health care, the system is designed to provide care at every stage. “If you have advanced kidney disease, you can get treatment,” says Levin, noting geographic and sociocultural limitations. The US approach of waiting until the final stages of a disease to guarantee treatment “absolutely ruins people’s ability to get prevention,” she says.
Even in countries that aim for early detection of kidney disease, many people cannot receive treatment until the disease progresses. “Kidney disease doesn’t show certain symptoms until late in the game,” says Tushar Vachharajani, an interventional nephrologist at Wayne State University School of Medicine in Detroit, Michigan. It’s a “silent killer,” he says.
End-stage renal disease is usually defined as renal function less than 15% of normal levels. However, symptoms often do not appear until kidney function drops below 20%. Such late onset means that people without health insurance or regular care are less likely to receive diagnosis and treatment in time to prevent progression.
In the United States, people of color consistently receive the most attention. Research has shown that dialysis facilities in the United States in communities where most of the residents are Black or Hispanic do worse than would otherwise be expected.3Regardless of an individual’s race or ethnicity, says Nephrologist Deidra Cruz, associate director of the Center for Health Equity at Johns Hopkins University in Baltimore, Maryland, Crews believes that community-level factors likely play an important role. I believe that These factors may limit access to other health care, healthy foods, services that support stable housing, and more.
Other Nature Outlooks articles
It’s clear that consistent health care can make a difference when it comes to preventing the progression of kidney disease, Cruz says. Yes, state-specific programs). A few years ago, some states, with federal funding, chose to expand Medicaid coverage under a law known as the Affordable Care Act. Crews points out that people who started a dialysis regime while living in states with expanded Medicaid coverage lived longer than those in states without expanded coverage.FourAlthough the underlying reasons are not fully understood, the fact that these people have access to care before starting dialysis means they are in a better position to maintain treatment. “We know that getting coverage before starting dialysis makes a difference,” says Crews.
Access to dialysis can also be difficult for certain populations, Crews said, because it depends on factors that doctors often neglect to ask. There is little or no community support or consistent access to food, let alone healthy options. If your income is low and you don’t even know when you can eat, it’s almost impossible to follow that diet,’ she says. Because they will be labeled and will not be considered for transplants or anything like that.”
In an ideal world, preventive care would be available to everyone, and doctors would be able to detect kidney disease early and slow its progression. Until then, dialysis is a stopgap solution that prolongs survival until donor organs become available. Dialysis is expensive, and countries’ healthcare budgets are disproportionately large for the few who need it. It is also available only to those who have access multiple times a week and have the resources to maintain that access.
Until better medical options emerge, improving people’s access to care before kidney failure develops is essential. We also aim to be acceptable. Back at the George Institute for Global Health in India, Jha and his colleagues are testing a portable, low-cost dialysis machine with the aim of introducing it into clinics as soon as possible. I hope that by telling her I can raise both awareness and funding so that she and countless others don’t die in vain.