Dialysis in developing countries: Priorities and obstacles

The incidence and prevalence of end stage renal failure (ESRD) is unknown in the developing countries due to lack of organized registries. The vast majority of ESRD patients are unable to gain access to dialytic therapy because of poverty, ignorance and lack of healthcare delivery systems. Even those who can manage to avail themselves of maintenance dialysis facility, continue to suffer from complications of uraemia due to inadequate dialysis. Because of the high costs involved in setting up and running haemodialysis units, a sudden growth in the number of dialysis units is not expected in the near future. Continuous ambulatory peritoneal dialysis (CAPD) has yet to gain wide acceptance. A successful renal transplant remains the only viable form of renal replacement therapy. Unless the policy makers decide to make special budgetary allocations for care of ESRD in developing countries, most of the patients would continue to die without receiving the benefits of modern therapy.