Browsing by Author "George Institute of Global Health"

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    Aetiology, practice patterns and burden of end-stage kidney disease in South Asia and South-East Asia: A questionnaire-based survey
    (2021-02-01) Manisha Sahay; Sanjiv Jasuja; Sydney Chi Wai Tang; Suceena Alexander; Vivekanand Jha; Tushar Vachharajani; Mamun Mostafi; Jayakrishnan K. Pisharam; Chakko Jacob; Atma Gunawan; Goh Bak Leong; Khin Thida Thwin; Rajendra Kumar Agrawal; Kriengsak Vareesangthip; Roberto Tanchanco; Lina Choong; Chula Herath; Chih Ching Lin; Nguyen The Cuong; Ha Phan Haian; Syed Fazal Akhtar; Ali Alsahow; Devinder S. Rana; Mohan M. Rajapurkar; Vijay Kher; Shalini Verma; Raja Ramachandran; Vinant Bhargava; Sonika Puri; Gaurav Sagar; Anupam Bahl; Sandeep Mandal; Ashwani Gupta; Maurizio Gallieni; Siriraj Hospital; Viet Nam National University Ho Chi Minh City; Ministry of Health Brunei; Bir Hospital; Sri Jayewardenepura General Hospital; Osmania General Hospital; Brawijaya University; Sindh Institute of Urology and Transplantation; Muljibhai Patel Urological Hospital; Queen Mary Hospital Hong Kong; Rutgers Robert Wood Johnson Medical School; Sir Ganga Ram Hospital; Cleveland Clinic Foundation; Indraprastha Apollo Hospitals; Singapore General Hospital; Veterans General Hospital-Taipei; Ospedale Luigi Sacco - Polo Universitario; Christian Medical College, Vellore; Postgraduate Institute of Medical Education & Research, Chandigarh; Jahara Hospital; Bangalore Baptist Hospital; Medanta Hospital; Columbia Asia Hospital; Clinical Research; University of Medicine 1; The Medical City; George Institute of Global Health; Armed Forces Medical College; Serdang Hospital; Viet Duc University Hospital
    Aim: There is paucity of data on the epidemiology of end-stage kidney disease (ESKD) from South Asia and South-East Asia. The objective of this study was to assess the aetiology, practice patterns and disease burden and growth of ESKD in the region comparing the economies. Methods: The national nephrology societies of the region; responded to the questionnaire; based on latest registries, acceptable community-based studies and society perceptions. The countries in the region were classified into Group 1 (High|higher-middle-income) and Group 2 (lower|lowermiddle income). Student t-test, Mann-Whitney U test and Fisher's exact test were used for comparison. Results: Fifteen countries provided the data. The average incidence of ESKD was estimated at 226.7 per million population (pmp), (Group 1 vs. Group 2, 305.8 vs. 167.8 pmp) and average prevalence at 940.8 pmp (Group 1 vs. Group 2, 1306 vs. 321 pmp). Group 1 countries had a higher incidence and prevalence of ESKD. Diabetes, hypertension and chronic glomerulonephritis were most common causes. The mean age in Group 2 was lower by a decade (Group 1 vs. Group 2—59.45 vs 47.7 years). Conclusion: Haemodialysis was the most common kidney replacement therapy in both groups and conservative management of ESKD was the second commonest available treatment option within Group 2. The disease burden was expected to grow >20% in 50% of Group 1 countries and 78% of Group 2 countries along with the parallel growth in haemodialysis and peritoneal dialysis.
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    Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia
    (2021-01-01) Suceena Alexander; Sanjiv Jasuja; Maurizio Gallieni; Manisha Sahay; Devender S. Rana; Vivekanand Jha; Shalini Verma; Raja Ramachandran; Vinant Bhargava; Gaurav Sagar; Anupam Bahl; Mamun Mostafi; Jayakrishnan K. Pisharam; Sydney C.W. Tang; Chakko Jacob; Atma Gunawan; Goh B. Leong; Khin T. Thwin; Rajendra K. Agrawal; Kriengsak Vareesangthip; Roberto Tanchanco; Lina H.L. Choong; Chula Herath; Chih C. Lin; Nguyen T. Cuong; Ha P. Haian; Syed F. Akhtar; Ali Alsahow; Mohan M. Rajapurkar; Vijay Kher; Hemant Mehta; Anil K. Bhalla; Umesh B. Khanna; Deepak S. Ray; Sonika Puri; Himanshu Jain; Aida Lydia; Tushar Vachharajani; Rabindranath Tagore International Institute of Cardiac Sciences; Siriraj Hospital; Bir Hospital; Sri Jayewardenepura General Hospital; Osmania General Hospital; Brawijaya University; Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo; Sindh Institute of Urology and Transplantation; Muljibhai Patel Urological Hospital; Queen Mary Hospital Hong Kong; Rutgers Robert Wood Johnson Medical School; Sir Ganga Ram Hospital; Cleveland Clinic Foundation; Indraprastha Apollo Hospitals; Singapore General Hospital; Veterans General Hospital-Taipei; Ospedale Luigi Sacco - Polo Universitario; Christian Medical College, Vellore; Postgraduate Institute of Medical Education & Research, Chandigarh; Lancelot Kidney and GI Centre; The Medical City; University of Medicine; Viet Duc University Hospital; Medanta Medicity; Avatar Foundation; Bangalore Baptist Hospital; Ministry of Health; Jahra Hospital; George Institute of Global Health; Lilawati Hospital; Hospital Serdang; Armed Forces Medical Institute
    Background. The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods. Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results. Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). "On-demand"hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%-20% in the majority of LE countries. Conclusion. Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.
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    Peritoneal dialysis: Status report in South and South East Asia
    (2021-11-01) Vinant Bhargava; Sanjiv Jasuja; Sydney Chi Wai Tang; Anil K. Bhalla; Gaurav Sagar; Vivekanand Jha; Raja Ramachandran; Manisha Sahay; Suceena Alexander; Tushar Vachharajani; Aida Lydia; Mamun Mostafi; Jayakrishnan K. Pisharam; Chakko Jacob; Atma Gunawan; Goh Bak Leong; Khin Thida Thwin; Rajendra Kumar Agrawal; Kriengsak Vareesangthip; Roberto Tanchanco; Lina Choong; Chula Herath; Chih Ching Lin; Syed Fazal Akhtar; Ali Alsahow; Devender Singh Rana; Mohan M. Rajapurkar; Vijay Kher; Shalini Verma; Sampathkumar Krishnaswamy; Amit Gupta; Anupam Bahl; Ashwani Gupta; Umesh B. Khanna; Santosh Varughese; Maurizio Gallieni; Siriraj Hospital; Ministry of Health Brunei; Bir Hospital; Sri Jayewardenepura General Hospital; Osmania General Hospital; Brawijaya University; Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo; Sindh Institute of Urology and Transplantation; Muljibhai Patel Urological Hospital; Queen Mary Hospital Hong Kong; Università degli Studi di Milano; Sir Ganga Ram Hospital; Meenakshi Mission Hospital and Research Centre; Cleveland Clinic Foundation; Indraprastha Apollo Hospitals; Singapore General Hospital; Veterans General Hospital-Taipei; Christian Medical College, Vellore; Postgraduate Institute of Medical Education & Research, Chandigarh; Apollo Medics Hospital; Lancelot Kidney and GI Centre; Bangalore Baptist Hospital; Medanta Hospital; Clinical Research; University of Dental Medicine; Jahra Hospital; The Medical City; George Institute of Global Health; Armed Forces Medical College; Hospital Serdang
    Background: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. Methods: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. Results: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%–7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with ‘PD first’ policy have the highest PD utilization. Conclusion: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.