Current Status of Chronic Kidney Disease Care in Southeast Asia

  • Vivekanand Jha
    Correspondence
    Address reprints requests to Vivekanand Jha, MD, DM, Additional Professor of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
    Affiliations
    Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    Search for articles by this author

      Summary

      Chronic kidney disease (CKD) is a major health problem for the underdeveloped countries of southeast Asia, home to more than 2 billion people. The true incidence and prevalence in the region is not known, but estimates suggest that the prevalence may be more than that reported in Western societies. The majority of affected individuals are young and in the most productive years of their lives. The looming epidemic of diabetes and hypertension is likely to further add to the disease burden. A high prevalence has been reported from some regions, suggesting the presence of unique etiologic factors. A large proportion of patients present late, with advanced kidney failure and multiple complications. Management is hampered by the lack of health care services, especially in the rural areas. The health care expenditure by the governments in these countries is very low, and there are no regional or national policies for chronic disease management including CKD. There is a major shortage of trained nephrologists. In absence of any government or private reimbursement, most patients cannot afford the high treatment cost. Renal replacement therapy is available only to a minority. The practice of dialysis in the region is not standardized and a large number of patients develop complications. There is an urgent need to develop CKD detection and prevention programs. Investigations are required to characterize the unique etiologic factors in different geographic regions so that prevention programs can be targeted appropriately. Cost-cutting strategies would make renal replacement therapy accessible to the general population. According sufficient prominence to CKD in education programs would help increase awareness.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Seminars in Nephrology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • United Nations Development Program
        Human development indices: a statistical update 2008.
        • Chugh K.S.
        • Jha V.
        Differences in the care of ESRD patients worldwide: required resources and future outlook.
        Kidney Int Suppl. 1995; 50: S7-S13
        • Jha V.
        • Chugh K.S.
        Dialysis in developing countries: priorities and obstacles.
        Nephrology (Carlton). 1996; 2: 65-72
        • Perkovic V.
        • Cass A.
        • Patel A.A.
        • Suriyawongpaisal P.
        • et al.
        High prevalence of chronic kidney disease in Thailand.
        Kidney Int. 2008; 73: 473-479
        • Modi G.K.
        • Jha V.
        The incidence of end-stage renal disease in India: a population-based study.
        Kidney Int. 2006; 70: 2131-2133
        • Domrongkitchaiporn S.
        • Sritara P.
        • Kitiyakara C.
        • Stitchantrakul W.
        • et al.
        Risk factors for development of decreased kidney function in a southeast Asian population: a 12-year cohort study.
        J Am Soc Nephrol. 2005; 16: 791-799
        • Ito J.
        • Dung D.T.
        • Vuong M.T.
        • Tuyen do G.
        • et al.
        Impact and perspective on chronic kidney disease in an Asian developing country: a large-scale survey in North Vietnam.
        Nephron Clin Pract. 2008; 109: c25-c32
        • Mani M.K.
        The management of end-stage renal disease in India.
        Artif Organs. 1998; 22: 182-186
        • Agarwal S.K.
        • Dash S.C.
        • Irshad M.
        • Raju S.
        • et al.
        Prevalence of chronic renal failure in adults in Delhi, India.
        Nephrol Dial Transplant. 2005; 20: 1638-1642
        • Barai S.
        • Bandopadhayaya G.P.
        • Patel C.D.
        • Rathi M.
        • et al.
        Do healthy potential kidney donors in India have an average glomerular filtration rate of 81.4 ml/min?.
        Nephron Physiol. 2005; 101: 21-26
        • Barai S.
        • Gambhir S.
        • Prasad N.
        • Sharma R.K.
        • et al.
        Levels of GFR and protein-induced hyperfiltration in kidney donors: a single-center experience in India.
        Am J Kidney Dis. 2008; 51: 407-414
        • Sakhuja V.
        • Jha V.
        • Ghosh A.K.
        • Ahmed S.
        • et al.
        Chronic renal failure in India.
        Nephrol Dial Transplant. 1994; 9: 871-872
        • Naqvi S.A.J.
        Nephrology services in Pakistan.
        Nephrol Dial Transplant. 2000; 15: 769-771
        • Sitprija V.
        Nephrology in South-East Asia.
        Kidney Int. 2003; 63: S128-S130
        • Lightstone L.
        • Rees A.J.
        • Tomson C.
        • et al.
        The incidence of end-stage renal disease in Indo-Asians in the UK.
        QJM. 1995; 88: 191-195
        • Bandara J.M.
        • Senevirathna D.M.
        • Dasanayake D.M.
        • Herath V.
        • et al.
        Chronic renal failure among farm families in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels in rice and freshwater fish (Tilapia).
        Environ Geochem Health. 2008; 30: 465-478
        • Peiris-John R.J.
        • Wanigasuriya J.K.
        • Wickremasinghe A.R.
        • Dissanayake W.P.
        • et al.
        Exposure to acetylcholinesterase-inhibiting pesticides and chronic renal failure.
        Ceylon Med J. 2006; 51: 42-43
        • Wanigasuriya K.P.
        • Peiris-John R.J.
        • Wickremasinghe R.
        • Hittarage A.
        Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease.
        Trans R Soc Trop Med Hyg. 2007; 101: 1013-1017
        • CKD Registry Group
        Report of the Chronic Kidney Disease Registry of India.
        Indian J Nephrol. 2008; 11: S1-S32
        • Srinath Reddy K.
        • Shah B.
        • Varghese C.
        • Ramadoss A.
        Responding to the threat of chronic diseases in India.
        Lancet. 2005; 366: 1744-1749
        • Le D.S.
        • Kusama K.
        • Yamamoto S.
        A community-based picture of type 2 diabetes mellitus in Vietnam.
        J Atheroscler Thromb. 2006; 13: 16-20
        • Bhargava S.K.
        • Sachdev H.S.
        • Fall C.H.
        • Osmond C.
        • et al.
        Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood.
        N Engl J Med. 2004; 350: 865-875
        • Jafar T.H.
        • Chaturvedi N.
        • Hatcher J.
        • Khan I.
        • et al.
        Proteinuria in South Asian children: prevalence and determinants.
        Pediatr Nephrol. 2005; 20: 1458-1465
        • Jafar T.H.
        • Islam M.
        • Poulter N.
        • Hatcher J.
        • et al.
        Children in South Asia have higher body mass-adjusted blood pressure levels than white children in the United States: a comparative study.
        Circulation. 2005; 111: 1291-1297
      1. Health at a Glance 2007: OECD indicators.
        2009 January 5
        • Rizvi A.
        • Aziz R.
        • Ahmed E.
        • Naqvi R.
        • et al.
        Recruiting the community for supporting end-stage renal disease management in the developing world.
        Artif Organs. 2002; 26: 782-784
        • The Sind Institute of Urology and Transplantation
        http://siut.org/statistics.htm
        Date: 2009 January 5
      2. Dialysis Registry of Pakistan 2006-2007. The Kidney Foundation, Karachi2008
        • Jha V.
        End-stage renal care in developing countries: the India experience.
        Ren Fail. 2004; 26: 201-208
        • Onn L.T.
        • Goh A.
        • Ngo L.Y.
        • Ghazalli R.
        • et al.
        Economics of dialysis.
        in: The National Renal Registry, Malaysian Society of Nephrology, Kuala Lumpur, Malaysia2007: 18-22
        • Chugh K.S.
        • Jha V.
        • Chugh S.
        Economics of dialysis and renal transplantation in the developing world.
        Transplant Proc. 1999; 31: 3275-3277
        • Jha V.
        Peritoneal dialysis in India: current status and challenges.
        Perit Dial Int. 2008; 28: S36-S41
        • Schoolwerth A.C.
        • Engelgau M.M.
        • Hostetter T.H.
        • Rufo K.H.
        • et al.
        Chronic kidney disease: a public health problem that needs a public health action plan.
        Prev Chronic Dis. 2006; 3: A57
        • Codreanu I.
        • Perico N.
        • Sharma S.K.
        • Schieppati A.
        • et al.
        Prevention programmes of progressive renal disease in developing nations.
        Nephrology (Carlton). 2006; 11: 321-328
        • Jafar T.H.
        The growing burden of chronic kidney disease in Pakistan.
        N Engl J Med. 2006; 354: 995-997
        • Mani M.K.
        Nephrologists sans frontieres: preventing chronic kidney disease on a shoestring.
        Kidney Int. 2006; 70: 821-823
        • Tsukamoto Y.
        • Morad Z.
        • Chen H.C.
        • et al.
        Report of the Second meeting of the Asian Forum of CKD initiative.
        Clin Exp Nephrol. 2009 Mar 14; (Clin Exp Nephrol) ([Epub ahead of print])
      3. CIA: The World Factbook.