Tomorrow, 10th of March, we celebrate World Kidney Day. Around the world, doctors, nurses, patients and the general public have an opportunity to highlight the importance of kidney disease prevention, as well as the added value of screening for early signs of kidney disease.
This year, the focus of World Kidney Day is kidney disease in childhood and, by extension, kidney disease in adulthood that has its roots in childhood. For those children who require renal replacement therapy (RRT) for acute and chronic kidney injury, access to the mentioned therapy (either hemodialysis or peritoneal dialysis) is more difficult than it is for adults.
In developed countries, RRT keeps over 2 million people alive worldwide, but optimal equipment and resources for children may not always be available. On the other hand, many developing countries have no readily accessible and affordable RRT programs, even for adults. Thus, patients who require these life-saving treatments may not survive unless they travel outside their home country for treatment. RRT in children is accessible only with extreme difficulty in many parts of developing countries, as equipment is either not available or hard to obtain. In addition, it is difficult to formulate policies to improve access to RRT for children.
A widespread problem that affects the care of children in all parts of the world…
Recently, a leading nephrologist from California was involved in arranging dialysis treatment for a 10-year old child. However, no single nephrologist or dialysis center in over a 100-mile radius felt comfortable treating a child. The family was thereby forced to drive 90-120 minutes to and then from a dialysis center in Los Angeles.
Such a situation in a developed area of the world suggests that mandatory 1-2 month pediatric nephrology rotations would be important for adult nephrologist fellows during their training, as well as for all those who take re-certification every 10 years, so that they can carry out RRT locally under the supervision of a remote pediatric nephrologist. Moreover, it would be important to mandate that all adult dialysis units obtain and maintain the needed equipment and techniques for pediatric patients.
The issue related to the proximity of a dialysis center where clinicians maintain pediatric expertise is compounded by the relative shortage of dialysis machines manufactured with children in mind. Thus, even in highly developed countries, treating children with advanced chronic kidney disease remains a challenge.
…and the problem is even more pressing in low-resource settings
A worse situation can be found in many developing countries, where access to dialysis is very limited or non-existing at all. Many children with acute kidney injury die unnecessarily because they don’t have access to dialysis.
In Nigeria, peritoneal dialysis (PD)1 is used more than hemodialysis (HD)2. It’s a cheaper renal therapy that can be adopted globally by low- and middle-income countries, which can further reduce the costs if the consumables are manufactured regionally or locally.
There is currently a shift in focus, favoring the choice of PD globally due to its better acceptability by patients, better maintenance of residual renal function, and its relative ease of performance in children. However, the cost of transporting or producing PD fluids and consumables has made it more expensive than HD in some regions lacking local production.
Help us improve the access to life-saving dialysis technology
Given the high cost of renal health care and the prevailing depressed economy, the management of a child with either acute or chronic kidney disease who requires RRT poses diverse challenges that contribute to the overall poor outcome of advanced renal disease as well as to high general mortality and morbidity in developing countries.
It would be important to consider renal disease in children as a global public health priority. International organizations and national governments should formulate policies that could alleviate the inaccessibility and unsustainability of RRT for children in resource-limited settings.
Help us spread the message by celebrating World Kidney Day and by being kidney-aware, wherever you are. You can obtain more information on http://www.worldkidneyday.org/
 Peritoneal dialysis uses a membrane inside the body (peritoneal membrane) as a filter to clear wastes and extra fluid from and to return electrolyte levels to normal. It doesn’t require travel to a dialysis center for the treatment.
 Hemodialysis is a process that uses a man-made membrane (dialyzer) to remove wastes – such as urea – from the blood, restore the proper balance of electrolytes in the blood and eliminate extra fluid from the body.