Asian Journal of Pediatric Nephrology

COMMENTARIES
Year
: 2021  |  Volume : 4  |  Issue : 1  |  Page : 3--5

Chronic kidney disease – End-stage kidney disease group


Ali Asghar Lanewala 
 Department of Pediatric Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan

Correspondence Address:
Ali Asghar Lanewala
Department of Pediatric Nephrology, Dewan Farooq Medical Complex, Sindh Institute of Urology and Transplantation, Deen Mohammed Wafai Road, Karachi 74800
Pakistan




How to cite this article:
Lanewala AA. Chronic kidney disease – End-stage kidney disease group.Asian J Pediatr Nephrol 2021;4:3-5


How to cite this URL:
Lanewala AA. Chronic kidney disease – End-stage kidney disease group. Asian J Pediatr Nephrol [serial online] 2021 [cited 2022 May 27 ];4:3-5
Available from: https://www.ajpn-online.org/text.asp?2021/4/1/3/320181


Full Text



Asia is home to almost 60% of the world population, with a current estimated population of about 4.6 billion people in 2021.[1] There are 48 countries in Asia including China and India, the two most populous countries of the world. About one-fifth of this population are in the 0–14 age group.[2] The estimated worldwide prevalence of advanced chronic kidney disease (CKD) in 2008 is ~18–100 per million age-related population.[3] This translates to about 1600–9000 children with advanced CKD in Asia. Most of the countries are lower-middle income with not only low gross national product but also limited public expenditure on health. Treatment facilities for children in most Asian countries are not widely available, especially in countries that are low- and low-middle income.[4] The prevalence of children in Nepal and Bangladesh who receive kidney replacement therapy, either in terms of maintenance dialysis or transplantation, is reported to be lower than 1 per million age-related population.[3],[5]

The Asian Society of Pediatric Nephrology (AsPNA) recently nominated a core group for CKD and End-Stage Kidney Disease (CKD-ESKD). It includes Lai Wai-Ming (Hong Kong), Hong Xu (China), Kenichiro Miura (Japan), Il Soo Ha (Korea), Khalid Alhasan (Saudi Arabia), Hamid Reza Badeali (Iran), Adisorn Lumpaopong (Thailand); Ali Asghar Lanewala (Pakistan) is the Chair.

The objectives of this group are to enable sharing the experience and expertise, in order to devise specific strategies for children with advanced CKD in the region. Existing international guidelines might need to be tailored according to available resources and require collaborative work to understand and address the epidemiology of kidney diseases in Asian countries.

 Key Challenges



The challenges that determine therapy for CKD-ESKD in the region are as follows:

The diversity in quality of health care, and the size of diseased children pose a major challenge to derive any recommendations or guidelines that are applicable to all the countriesThere are very few national registries for CKD-ESRD in Asian countries. There is limited knowledge about the common causes of CKD and burden of the disease in most countries. Some of the treatable and preventable causes leading to kidney failure are common in certain countries that can be addressed through this platformAvailable treatment facilities may vary from advanced to minimal facilities based on the socioeconomic status of countries. Densely populated countries such as China, India, Indonesia, Thailand, Pakistan, and Bangladesh have limited facilities in the rural areas, whereas urban centers in these countries can provide advanced health care. Such treatment facilities are mostly available in the private sector and not accessible to the majority of the population. On the other hand, patients in Japan, Singapore, Korea, Hong Kong, Saudi Arabia, and United Arab Emirates have access to advanced care, through state-funded health careTransplantation facilities, especially deceased organ transplantation, are not available in a majority of the countries. In some countries, advanced diagnostic and treatment modalities for the management of rejection and infections posttransplant are not available, resulting in compromised graft survivalFacilities for the early diagnosis and preventive therapies, including reconstructive surgeries for children with congenital anomalies of the kidney and urinary tract are often scarce. Similarly, the approaches to improve public education about the early recognition of such diseases are also lacking in many developing countries.

 Pilot Survey



We did a pilot survey through a questionnaire to all country representatives of the AsPNA to evaluate their facilities for the dialysis and transplantation [Table 1] and [Table 2]. Only 10 member countries responded. A national registry for CKD is present in five countries. The most common mode for vascular access for hemodialysis was through double-lumen catheters. Continuous cyclic peritoneal dialysis was available chiefly in Korea. While facilities for pediatric transplantation were available in all ten countries, an active deceased donor program was present only in five.{Table 1}{Table 2}

 Proposed Collaboration



We propose to collaborate with the International Pediatric Nephrology Association to collect and analyze the data from Asian countries. This will help get more information on epidemiology and existing facilities, which in turn will help identify the specific areas where members of the AsPNA can focus their services to improve the health care of children suffering from kidney diseases.

References

1Population of Asia – Worldometer. 2021. Available from: http://www. worldometers.info. [Last accessed on 2021 May 14].
2Population ages 0-14 (% of total population),Data. Available from: http://www.worldbank.org. [Last accessed on 2021 May 14].
3Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol 2012;27:363-73.
4Harambat J, Ekulu PM. Inequalities in access to pediatric ESRD care: A global health challenge. Pediatr Nephrol 2016;31:353-8.
5Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: A systematic review. Lancet 2015;385:1975-82.