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Hemodialysis versus peritoneal dialysis in resource-limited settings

Niang, Abdoua,*; Iyengar, Arpanab,*; Luyckx, Valerie A.c

Current Opinion in Nephrology and Hypertension: November 2018 - Volume 27 - Issue 6 - p 463–471
doi: 10.1097/MNH.0000000000000455
DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker

Purpose of review To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings.

Recent findings Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally.

Summary Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.

aInternal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Sénégal

bDepartment of Pediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India

cInstitute of Biomedical Ethics and the History of Medicine, University of Zurich, Winterthurerestrasse, Zurich, Switzerland

Correspondence to Valerie A. Luyckx, Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Winterthurerestrasse 30, Zurich 8006, Switzerland. Tel: +41 76 617 3343; e-mail:

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