The dangers of rationing dialysis treatment: The dilemma facing a developing country

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dc.contributor.authorMoosa M.R.
dc.contributor.authorKidd M.
dc.date.accessioned2011-05-15T16:17:17Z
dc.date.available2011-05-15T16:17:17Z
dc.date.issued2006
dc.description.abstractThe increasing burden of chronic kidney disease places enormous strains on resources of all countries, but especially of those with emerging economies. Few developing countries are able to afford dialysis programs and those that do ration this scarce resource. In South Africa, rationing has been practiced since the introduction of dialysis. Our renal unit carefully screened patients with end-stage kidney disease (ESKD) based on certain medical and socioeconomic criteria. The outcome of these decisions taken by the Assessment Committee is reviewed in this study. Details of the 2442 patients with ESKD assessed between 1988 and 2003 for the renal replacement program were captured. Using univariate and multivariate analysis, the odds of being accepted for treatment based on several variables were determined. The majority (52.7%) of patients with ESKD were not offered renal replacement therapy in the period of study. The number of kidney transplants progressively decreased, as did the number of patients accepted. The patients mostly likely to be accepted for renal replacement therapy were aged 20-40 years, white, employed, married, non-diabetic, and lived in proximity to a dialysis center. Almost 60% of patients were denied renal replacement treatment because of social factors related to poverty. In a developing country, where rationing of treatment is unavoidable, it is difficult to ensure equity of treatment and certain groups are advantaged over others. In our experience, socioeconomic factors influenced decision to accept patients more profoundly than medical ones. © 2006 International Society of Nephrology.
dc.description.versionArticle
dc.identifier.citationKidney International
dc.identifier.citation70
dc.identifier.citation6
dc.identifier.issn00852538
dc.identifier.other10.1038/sj.ki.5001750
dc.identifier.urihttp://hdl.handle.net/10019.1/14154
dc.subjectadult
dc.subjectarticle
dc.subjectconservative treatment
dc.subjectdemography
dc.subjectdeveloping country
dc.subjectdialysis
dc.subjectfemale
dc.subjecthuman
dc.subjectkidney failure
dc.subjectkidney transplantation
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectpoverty
dc.subjectpriority journal
dc.subjectrenal replacement therapy
dc.subjectsocial aspect
dc.subjectAdult
dc.subjectAfrican Continental Ancestry Group
dc.subjectDecision Making
dc.subjectDeveloping Countries
dc.subjectEuropean Continental Ancestry Group
dc.subjectFemale
dc.subjectHealth Care Rationing
dc.subjectHumans
dc.subjectKidney Failure, Chronic
dc.subjectKidney Transplantation
dc.subjectMale
dc.subjectPrevalence
dc.subjectRenal Dialysis
dc.subjectRetrospective Studies
dc.subjectSocioeconomic Factors
dc.subjectSouth Africa
dc.titleThe dangers of rationing dialysis treatment: The dilemma facing a developing country
dc.typeArticle
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