Ethical Challenges in the Provision of Dialysis in Resource-Constrained Environments

Seminars in Nephrology

Volumn 37, Issue 3, 2017, Pages 273-286

  Luyckx, Valerie A ^a,b   Miljeteig, Ingrid ^c,d   Ejigu, Addisu M ^e   Moosa, M Rafique ^f  

^a UNIVERSITY OF ZURICH   (Switzerland)

^b BRIGHAM AND WOMEN S HOSPITAL   (United States)

^c UNIVERSITY OF BERGEN   (Norway)

^d Bergen Health   (Norway)

^e ADDIS ABABA UNIVERSITY   (Ethiopia)

^f UNIVERSITY OF STELLENBOSCH   (South Africa)

Author keywords

accountability for reasonableness; Dialysis; ethics; low and middle income countries; priority setting; rationing

Indexed keywords

DECISION MAKING; DISEASE COURSE; DISEASE EXACERBATION; DOCTOR PATIENT RELATION; END STAGE RENAL DISEASE; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEMODIALYSIS; HUMAN; JUSTICE; PATIENT ADVOCACY; PATIENT AUTONOMY; PRACTICE GUIDELINE; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; DISEASE MANAGEMENT; ETHICS; HEALTH CARE PLANNING; KIDNEY DISEASE; SOCIAL RESPONSIBILITY;

DECISION MAKING; DISEASE MANAGEMENT; HEALTH RESOURCES; HUMANS; KIDNEY DISEASES; RENAL DIALYSIS; SOCIAL RESPONSIBILITY;

EID: 85017160474     PISSN: 02709295     EISSN: 15584488     Source Type: Journal    
DOI: 10.1016/j.semnephrol.2017.02.007     Document Type: Review

References (95)

1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385 (2015), 117–171.
2. Mehta, R.L., Cerda, J., Burdmann, E.A., et al. International Society of Nephrology׳s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 385 (2015), 2616–2643.
3. Stanifer, J.W., Muiru, A., Jafar, T.H., Patel, U.D., Chronic kidney disease in low- and middle-income countries. Nephrol Dial Transplant 31 (2016), 868–874.
4. Mills, K.T., Xu, Y., Zhang, W., et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int 88 (2015), 950–957.
5. Mehta, R.L., Burdmann, E.A., Cerda, J., et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 global snapshot: a multinational cross-sectional study. Lancet 387 (2016), 2017–2025.
6. Olowu, W.A., Niang, A., Osafo, C., et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health 4 (2016), e242–e250.
7. Thomas, B., Wulf, S., Bikbov, B., et al. Maintenance dialysis throughout the world in years 1990 and 2010. J Am Soc Nephrol 26 (2015), 2621–2633.
8. Liyanage, T., Ninomiya, T., Jha, V., et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385 (2015), 1975–1982.
9. Anand, S., Bitton, A., Gaziano, T., The gap between estimated incidence of end-stage renal disease and use of therapy. PLoS One, 8, 2013, e72860.
10. Danovitch, G.M., Chapman, J., Capron, A.M., et al. Organ trafficking and transplant tourism: the role of global professional ethical standards-the 2008 Declaration of Istanbul. Transplantation 95 (2013), 1306–1312.
11. Garcia, G.G., Harden, P., Chapman, J., The global role of kidney transplantation. Saudi J Kidney Dis Transpl 23 (2012), 215–222.
12. Mani, M.K., The management of end-stage renal disease in India. Artif Organs 22 (1998), 182–186.
13. Couser, W.G., Remuzzi, G., Mendis, S., Tonelli, M., The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 80 (2011), 1258–1270.
14. Garcia-Garcia, G., Jha, V., World Kidney Day Steering Committee. CKD in disadvantaged populations. Kidney Int 87 (2015), 251–253.
15. Brouwer, E.D., Watkins, D., Olson, Z., Goett, J., Nugent, R., Levin, C., Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review. BMC Public Health, 15, 2015, 1183.
16. Parameswaran, S., Geda, S.B., Rathi, M., et al. Referral pattern of patients with end-stage renal disease at a public sector hospital and its impact on outcome. Natl Med J India 24 (2011), 208–213.
17. Francis, E.R., Allen, A.K., Herrera-Anazco, P., et al. Establishing a higher priority for chronic kidney disease in Peru. Lancet Glob Health 4 (2016), e17–e18.
18. White, S.L., Chadban, S.J., Jan, S., Chapman, J.R., Cass, A., How can we achieve global equity in provision of renal replacement therapy?. Bull World Health Org 86 (2008), 229–237.
19. Obrador, G.T., Rubilar, X., Agazzi, E., Estefan, J., The challenge of providing renal replacement therapy in developing countries: the Latin American perspective. Am J Kidney Dis 67 (2016), 499–506.
20. Garcia-Garcia, G., Monteon-Ramos, J.F., Garcia-Bejarano, H., et al. Renal replacement therapy among disadvantaged populations in Mexico: a report from the Jalisco Dialysis and Transplant Registry (REDTJAL). Kidney Int Suppl 97 (2005), S58–S61.
21. Kher, V., End-stage renal disease in developing countries. Kidney Int 62 (2002), 350–362.
22. Olowu, W.A., Renal failure in Nigerian children: factors limiting access to dialysis. Pediatr Nephrol 18 (2003), 1249–1254.
23. Elamin, S., Obeid, W., Abu-Aisha, H., Renal replacement therapy in Sudan, 2009. Arab J Nephrol Transplant 3 (2010), 31–36.
24. Odubanjo, M.O., Oluwasola, A.O., Kadiri, S., The epidemiology of end-stage renal disease in Nigeria: the way forward. Int Urol Nephrol 43 (2011), 785–792.
25. Antwi, S., State of renal replacement therapy services in Ghana. Blood Purif 39 (2017), 137–140.
26. Callegari, J., Antwi, S., Wystrychowski, G., Zukowska-Szczechowska, E., Levin, N.W., Carter, M., Peritoneal dialysis as a mode of treatment for acute kidney injury in sub-Saharan Africa. Blood Purif 36 (2013), 226–230.
27. Van Biljon, G., Causes, prognostic factors and treatment results of acute renal failure in children treated in a tertiary hospital in South Africa. J Trop Pediatr 54 (2008), 233–237.
28. Ajayi, S., Raji, Y., Bello, T., Jinadu, L., Salako, B., Unaffordability of renal replacement therapy in Nigeria. Hong Kong J Nephrol 18 (2016), 15–19.
29. Jha, V., Current status of end-stage renal disease care in South Asia. Ethn Dis, 19(Suppl 1), 2009 S1-27-32.
30. Niang, A., Cisse, M.M., Mahmoud, S.M., Lemrabott, A.T., Ka el, H.F., Diouf, B., Pilot experience in Senegal with peritoneal dialysis for end-stage renal disease. Perit Dial Int 34 (2014), 539–543.
31. Bah, A.O., Lamine, C., Balde, M.C., Bah, M.L., Rostaing, L., Epidemiology of chronic kidney diseases in the Republic of Guinea; future dialysis needs. J Nephropathol 4 (2015), 127–133.
32. Khanna, U., The economics of dialysis in India. Indian J Nephrol 19 (2009), 1–4.
33. Dreyer, G., Dobbie, H., Banks, R., et al. Supporting Malawi׳s dialysis services with the international community. Br J Renal Med 17 (2012), 24–26.
34. Butler, C.R., Mehrotra, R., Tonelli, M.R., Lam, D.Y., The evolving ethics of dialysis in the United States: a principlist bioethics approach. Clin J Am Soc Nephrol 11 (2016), 704–709.
35. Alexander, S., They decide who lives, who dies: medical miracle and a moral burden of a small committee. Life Magazine, Nov 9, 1962.
36. Rettig, R.A., Special treatment–the story of Medicare׳s ESRD entitlement. N Engl J Med 364 (2011), 596–598.
37. Schreiner, G.E., How end-stage renal disease (ESRD)-Medicare developed. Am J Kidney Dis 35:Suppl 1 (2000), S37–S44.
38. Tantivess, S., Werayingyong, P., Chuengsaman, P., Teerawattananon, Y., Universal coverage of renal dialysis in Thailand: promise, progress, and prospects. BMJ, 346, 2013, f462.
39. Kahrass, H., Strech, D., Mertz, M., The full spectrum of clinical ethical issues in kidney failure. findings of a systematic qualitative review. PLoS One, 11, 2016, e0149357.
40. Davison, S.N., Levin, A., Moss, A.H., et al. Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: developing a roadmap to improving quality care. Kidney Int 88 (2015), 447–459.
41. Hussain, J.A., Flemming, K., Murtagh, F.E., Johnson, M.J., Patient and health care professional decision-making to commence and withdraw from renal dialysis: a systematic review of qualitative research. Clin J Am Soc Nephrol 10 (2015), 1201–1215.
42. Azetsop, J., Rennie, S., Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?. Philos Ethics Humanit Med, 5, 2010, 1.
43. Jha, V., ESRD burden in South Asia: the challenges we are facing. Clin Nephrol 83:Suppl 1 (2015), 7–10.
44. Lou-Meda, R., ESRD in Guatemala and a model for preventive strategies: outlook of the Guatemalan Foundation for Children with Kidney Diseases. Ren Fail 28 (2006), 689–691.
45. Ulasi, I., Gender bias in access to healthcare in Nigeria: a study of end-stage renal disease. Trop Doct 38 (2008), 50–52.
46. Harambat, J., Ekulu, P.M., Inequalities in access to pediatric ESRD care: a global health challenge. Pediatr Nephrol 31 (2016), 353–358.
47. Miljeteig, I.M.A., Berhane, F., Dessie, E., Onarheim, K.H., Priorities at the bedside: experiences of catastrophic health expenditures in Ethiopia. Global health priority-setting: beyond cost-effectiveness, 2016 In press 2017.
48. Yilma, Z., Mebratie, A., Sparrow, R., et al. Coping with shocks in rural Ethiopia. J Dev Studies 50 (2014), 1009–1024.
49. Ramachandran, R., Jha, V., Kidney transplantation is associated with catastrophic out of pocket expenditure in India. PLoS One, 8, 2013, e67812.
50. Prakongsai, P., Palmer, N., Uay-Trakul, P., Tangcharoensathien, V., Mills, A., The implications of benefit package design: the impact on poor Thai households of excluding renal replacement therapy. J Int Dev 21 (2009), 291–308.
51. Ekrikpo, U.E., Udo, A.I., Ikpeme, E.E., Effa, E.E., Haemodialysis in an emerging centre in a developing country: a two year review and predictors of mortality. BMC Nephrol, 12, 2011, 50.
52. Onwujekwe, O., Hanson, K., Uzochukwu, B., Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria. PLoS One, 7, 2012, e40811.
53. Kruk, M.E., Mbaruku, G., Rockers, P.C., Galea, S., User fee exemptions are not enough: out-of-pocket payments for ׳free׳ delivery services in rural Tanzania. Trop Med Int Health 13 (2008), 1442–1451.
54. Storeng, K.T., Baggaley, R.F., Ganaba, R., Ouattara, F., Akoum, M.S., Filippi, V., Paying the price: the cost and consequences of emergency obstetric care in Burkina Faso. Soc Sci Med 66 (2008), 545–557.
55. Xu, K., Evans, D.B., Kawabata, K., Zeramdini, R., Klavus, J., Murray, C.J., Household catastrophic health expenditure: a multicountry analysis. Lancet 362 (2003), 111–117.
56. Tangcharoensathien, V., Pitayarangsarit, S., Patcharanarumol, W., et al. Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity. Health Res Policy Syst, 11, 2013, 25.
57. Odetunde, O.I., Okafor, H.U., Uwaezuoke, S.N., Ezeonwu, B.U., Ukoha, O.M., Renal replacement therapy in children in the developing world: challenges and outcome in a tertiary hospital in southeast Nigeria. ScientificWorldJournal, 2014, 2014, 903151.
58. Gillam, L., Sullivan, J., Ethics at the end of life: who should make decisions about treatment limitation for young children with life-threatening or life-limiting conditions?. J Paediatr Child Health 47 (2011), 594–598.
59. Dare, T., Parental rights and medical decisions. Paediatr Anaesth 19 (2009), 947–952.
60. Miljeteig, I., Sayeed, S.A., Jesani, A., Johansson, K.A., Norheim, O.F., Impact of ethics and economics on end-of-life decisions in an Indian neonatal unit. Pediatrics 124 (2009), e322–e328.
61. Sharif, M.U., Elsayed, M.E., Stack, A.G., The global nephrology workforce: emerging threats and potential solutions!. Clin Kidney J 9 (2016), 11–22.
62. Defaye, F.B., Desalegn, D., Danis, M., et al. A survey of Ethiopian physicians׳ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences. BMC Health Serv Res, 15, 2015, 467.
63. Kapiriri, L., Martin, D.K., Bedside rationing by health practitioners: a case study in a Ugandan hospital. Med Decis Making 27 (2007), 44–52.
64. Abdelwahab, H.H., Shigidi, M.M., Barriers to adequate urea clearance among hemodialysis patients in developing countries: an example from the Sudan. Saudi J Kidney Dis Transpl 26 (2015), 144–148.
65. Ulasi, I.I., Ijoma, C.K., The enormity of chronic kidney disease in Nigeria: the situation in a teaching hospital in South-East Nigeria. J Trop Med, 2010, 2010, 501957.
66. Keshaviah, P., Resource limitations and strategies for the treatment of uremia. A dialysis unit in the Himalayan foothills. Blood Purif 19 (2001), 44–52.
67. Persad, G.C., Emanuel, E.J., The ethics of expanding access to cheaper, less effective treatments. Lancet 388 (2016), 932–934.
68. Abdelwahab, H.H., Shigidi, M.M.T., Ibrahim, L.S., El-Tohami, A.K., Barriers to kidney transplantation among adult Sudanese patients on maintenance hemodialysis in dialysis units in Khartoum State. Saudi J Kidney Dis Transplant 24 (2013), 1044–1049.
69. Elamin, S., Abu-Aisha, H., Reaching target hemoglobin level and having a functioning arteriovenous fistula significantly improve one year survival in twice weekly hemodialysis. Arab J Nephrol Transplant 5 (2012), 81–86.
70. Persad, G., Wertheimer, A., Emanuel, E.J., Principles for allocation of scarce medical interventions. Lancet 373 (2009), 423–431.
71. Halle, M.P., Takongue, C., Kengne, A.P., Kaze, F.F., Ngu, K.B., Epidemiological profile of patients with end stage renal disease in a referral hospital in Cameroon. BMC Nephrol, 16, 2015, 59.
72. Bieber, B., Qian, J., Anand, S., et al. Two-times weekly hemodialysis in China: frequency, associated patient and treatment characteristics and quality of life in the China Dialysis Outcomes and Practice Patterns study. Nephrol Dial Transplant 29 (2014), 1770–1777.
73. World Health Organization. Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and INversal Health Coverage, 2014 [cited 2016 June 30]. Available from: http://apps.who.int/iris/bitstream/10665/112671/1/9789241507158_eng.pdf?ua=1.
74. Daniels, N., Sabin, J.E., Setting limits fairly. Learning to share resources for health, 2 ed, 2008, Oxford University Press, New York.
75. Norheim, O.F., Ethical perspective: five unacceptable trade-offs on the path to universal health coverage. Int J Health Policy Manag 4 (2015), 711–714.
76. Luyckx, V.A., Naicker, S., McKee, M., Equity and economics of kidney disease in sub-Saharan Africa. Lancet 382 (2013), 103–104.
77. Marckmann, G., Schmidt, H., Sofaer, N., Strech, D., Putting public health ethics into practice: a systematic framework. Front Public Health, 3, 2015, 23.
78. Rawls, J., A theory of justice. 1971, Harvard University Press, Cambridge, MA.
79. Daniels, N., Justice, health, and health care. Am J Bioeth 1 (2001), 2–16.
80. Daniels, N., Sabin, J., The ethics of accountability in managed care reform. Health Aff (Millwood) 17 (1998), 50–64.
81. Daniels, N., Meeting health needs fairly. 2008, Cambridge University Press, Cambridge.
82. Kevany, S., Benatar, S.R., Fleischer, T., Improving resource allocation decisions for health and HIV programmes in South Africa: bioethical, cost-effectiveness and health diplomacy considerations. Glob Public Health 8 (2013), 570–587.
83. Sidley, P., South African row over denial of dialysis. BMJ, 315, 1997, 1562.
84. Moosa, M.R., Kidd, M., The dangers of rationing dialysis treatment: the dilemma facing a developing country. Kidney Int 70 (2006), 1107–1114.
85. Moosa, M.R., Team, R.S.T., Guideline: priority setting approach in the selection of patients in the public sector with end-stage kidney failure for renal replacement treatment in the Western cape province, 2010 Available from: https://assets.documentcloud.org/documents/19489/moosa-priority-setting-policy-final-feb-24-2010-final.pdf Accessed 01.08.15.
86. Gibson, D., The liminality of kidney failure in South African state hospitals. Anthropol S Afr 34 (2011), 74–81.
87. Benatar, S.R., Gill, S., Bakker, I., Global health and the global economic crisis. Am J Public Health 101 (2011), 646–653.
88. Jha, V., Garcia-Garcia, G., Iseki, K., et al. Chronic kidney disease: global dimension and perspectives. Lancet 382 (2013), 260–272.
89. GBD 2013 Risk Factors Collaborators, Forouzanfar, M.H., Alexander, L., et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386 (2015), 2287–2323.
90. Rettig, R.A., The policy debate on patient care financing for victims of end-stage renal disease. Law Contemp Probl 40 (1976), 196–230.
91. El-Tigani, M.A., Abdelraheem, M.B., Mohamed, R.M., Hassan, E.G., Watson, A.R., Chronic renal failure in Sudanese children: aetiology and outcomes. Pediatr Nephrol 24 (2009), 349–353.
92. Schmidt, H., Gostin, L.O., Emanuel, E.J., Public health, universal health coverage, and sustainable development goals: can they coexist?. Lancet 386 (2015), 928–930.
93. Abdelraheem, M., Ali el, T., Osman, R., et al. Outcome of acute kidney injury in Sudanese children - an experience from a sub-Saharan African unit. Perit Dial Int 34 (2014), 526–533.
94. Norheim, O.F., Baltussen, R., Johri, M., et al. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc, 12, 2014, 18.
95. Teerawattananon, Y., Mugford, M., Tangcharoensathien, V., Economic evaluation of palliative management versus peritoneal dialysis and hemodialysis for end-stage renal disease: evidence for coverage decisions in Thailand. Value Health 10 (2007), 61–72.