How dialysis works in developing countries

Currently, we are facing a situation where many people in the world are suffering from kidney-related diseases. In fact, according to the National Kidney Foundation, at least 10% of the global population suffers from chronic kidney disease, and at least two million people receive dialysis treatment nowadays. Sadly, most of the patients who actually have access to dialysis treatment are those who live in developed countries. Those who live in developing countries not always have access to the treatment, and when they do it is often unsatisfying.

It is not a secret that for those patients who have end stage renal disease or ESRD, dialysis becomes the only alternative to survive before actually thinking about getting a kidney transplant. However, if you are living in a developing country and don’t have the resources to pay for private treatment, your chances of being properly treated can run really low.

intensive-care area of the El Fasher Hospital_developing countries

Image courtesy of UNAMID at Flickr.com

Poverty, ignorance and the lack of medical resources are some of the most common elements that affect the possibilities patients have to access dialysis. Even sometimes, when patients have the chance to pay for a better treatment, this is not available in their region and there is little or nothing they can do about it once they are sick.

So, why all this happens? In this article, we will explore the main factors related to the way dialysis treatment takes place in developing countries. All this keeping in mind that many of the patients who need dialysis in these countries actually don’t know about it. This happens either because they cannot afford to go to the doctor, their healthcare systems are also poor, their records are not properly kept, or simply because they lack the will or intention to go to the doctor under these unpleasant circumstances.

Let’s take a look to some of the most important issues that affect the way patients who need dialysis treatment are actually treated in developing countries.

High costs

This is the most obvious and common factor related to many things that don’t operate properly in developing countries. When it comes to treating ESRD patients, healthcare providers face a critical situation because their ethics tells them they should treat the patients properly. However, the financial capacity keeps them away from actually doing so.

Setting and running a dialysis unit is rather expensive. Even though every country in the world has patients with kidney disease among its population, not many institutions have the needed resources to start a dialysis unit. Besides, when these dialysis units are actually set, they will need to keep on growing and being properly maintained. This also implies expenses related to the unit’s operation that many institutions can’t afford.

Machine problems

Let’s say that the dialysis unit was created. All the machines in it will need to be properly taken care of in order for it to be sustainable. Most times, the machines that are kept in good shape remain in the cities, where technicians and medical equipment companies are located at. This leaves the poorest areas of developing countries aside. Therefore, people who live in the areas (which also happen to be the poorest) has little or no chances to access the dialysis services.

Another problem related to dialysis machines is that they are not always enough to treat all the patients. In addition, the available machines are not often functioning and present multiple problems like breakdowns, missing parts, or obsolete systems. All this is being considered also keeping in mind that in some low-income areas power can also be off.

Staff problems

Problems related to machines are not the only ones to come. We also need to keep in mind that in order to use one of these dialysis machines, we need to count on the help of a prepared staff member, who knows how to use the machine.

Military Hospital_health_medicine

Image courtesy of US Army Africa at Flickr.com

Here we face bigger problems because sometimes there are not properly educated individuals who know how to operate the dialysis machines and when there are, wages are usually not enough for them to make a living out of it.

All this crisis happens because many of the dialysis units depend on the state. Public hospitals and public health care facilities are often poorly financed in developing countries, which makes it hard for the ideal staff to work at these places and operate dialysis units. As a consequence of this, many units need to close because they don’t have the required staff to work at them, and once they are restructured, they can be opened again.

It is important to keep in mind, that matter how poor a country is, the motivation of people to work is usually directly related to the amount of money that is being paid to them. If there are no resources to cover up for the staff expenses, then there won’t be enough or well-prepared people to work at dialysis units.

Related: The Most Common Questions Patients Have About Dialysis by Joe Cosgrove

* Featured Image courtesy of Albert González Farran, UNAMID at Flickr.com

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Understanding the 5 stages of Chronic Kidney Disease

We do not have to stress out or even define what CKD is because we have discussed it in this blog in several articles and we already know what it is all about.

Instead today we are going to take a deep look at the 5 stages of Chronic Kidney Disease that were developed or designed by the National Kidney Foundation (NKF) in order to understand better Kidney diseases and to give doctors  some sort of guideline that will help them identify the evolution of the kidney disease and know how to give the patient the best care possible for each stage.

FIVE_5 stages of Chronic Kidney Disease

Image courtesy of electricnude at Flickr.com

Let’s take a look at those 5 stages.

Stage 1 and 2:

Somebody that is in stage 1 or 2 of CKD has a small kidney damage and his or her glomerular filtration rate (GFR) is normal or a bit higher than 90 ml/min. in this stage, symptoms are not common and the kidneys are still working normally. If the person is to find out he or she is on stage 1 CKD it is because the person was being tested for other things and the results came out with certain amount of creatinine levels or they discovered blood or protein in the urine or there was an imaging test and the results said there was a kidney damage.

For people that are in this stage the treatment only focuses on a healthy diet including whole grains, fresh fruits and vegetables, no fats or low fat diets, control the intake of sugar and sodium, have a good weight and exercise very regularly, take vitamins recommended by doctors and definitively stop smoking and having bad habits for the body.

When it comes to stage 2, the description is just the same with the disease having no symptoms and the kidney working at a very good level. The only difference here is that the kidney already has a mild damage and it is getting a bit late to discover it or to treat it and the glomerular filtration rate is around 60-89 ml/min.

Stage 3:

Here the person has already a moderate kidney damage. This stage has two parts which are called A and B. in stage 3A the glomerular filtration rate is 45-59 mL/min, and in stage 3B the glomerular filtration rate is 30-44 mL/min.  Here the disease is already noticeable and patients start to feel the symptoms. A condition called uremia appears and secondary complications such as high blood pressure, anemia and bone disease start to appear as well.

The symptoms for this stage are the feeling of being tired all the time, high retention of fluids, extremities start to swell and the patient starts feeling that his or her breath is just not enough, urine changes color to a more reddish, brownish color or it even contains blood which will make it red, lower back pain, problems with sleep and muscle cramps.

In this stage, the kidney is working at a 50% performance and the idea is to help the patient keep their kidneys working as long as possible.

In this stage, a very controlled diet and medications are essential to make the kidney live longer. When it comes to medications ( the diet is very important even since stage 1) in this stage they become essential to control glucose levels and have a very good blood pressure in order to maintain the kidney working for as long as possible. The medications doctors prescribe in this stage are ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers).

Stage 4:

Here the patient has a real problem that needs to be tackled as soon as possible and with the correct treatment. Their glomerular filtration rate is 15-30 ml/min. and treatments are now very viable options. Unfortunately, a patient with stage 4 CKD will have to get a kidney transplant in the near future. In this stage conditions like anemia, uremia, bone disease, high blood pressure, heart complications and cardiovascular diseases start to become present.

The symptoms in this stage are fatigue, hard kidney pain in the lower back, sleeping problems, nausea, vomiting, a  metallic taste in their mouth, bad breath, loss of appetite due to the flavor in their mouth, difficulty in concentrating and numbness or tingling in the toes or fingers.

In this stage, there are 3 different types of treatments which are Hemodialysis, Peritoneal dialysis and, Kidney transplant

Stage 5:

Unfortunately, at this stage, the person has no options and it is a terminal disease called end-stage renal disease (ESRD) that has a glomerular filtration rate of 15 ml/min or less. In this stage, the kidneys no longer work and don’t have the ability to do anything at all. In this stage dialysis or a kidney transplant will be needed to survive.  

It is very important to understand these five stages so patients and doctors can find out about the disease in the early stages and give patients the option of having a very good quality of life.

Be sure to also read this post about how to choose the right treatment in case of renal failure?