title: How to make peritoneal dialysis affordable in developing countries.
abstract: Peritoneal dialysis (PD) is an underutilized renal replacement therapy in the developing world. It offers advantages of simplicity, reduced need of training, lack of dependence on infrastructure and location. The population is extremely underserved by healthcare and means to achieve it. PD is unavailable in many African nations. We explore the logistics of PD, domestic manufacture of PD fluid and accessories and ways to sustain it. Realization of local factors, ways to reduce peritonitis, reduced dosage in patients with residual renal function and use of generics to treat anemia that help improve the logistics. The role of national government especially in countries where dialysis is rationed and its lack of involvement leaving the billions to fetch for themselves is discussed. Innovative schemes by private insurers have improved PD outcome locally. These include subsidized once-in-a-lifetime PD treatment payment and industry sponsored nurse and technician visits to patients. Finally, the factors preventing nephrologists in delivering PD such as lack of training, reimbursement, infrastructure and affordability are discussed.
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
authors.forename: Pallavi
authors.initials: P
authors.lastname: Khanna
authors.forename: Milly
authors.initials: M
authors.lastname: Mathew
authors.forename: Poorna
authors.initials: P
authors.lastname: Pushpkala
authors.forename: Anurag
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Aswin
authors.initials: A
authors.lastname: Sairam
authors.forename: Asik Ali
authors.initials: AA
authors.lastname: Mohamed Ali
mesh_terms: D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006078:Government Programs / Q000191:economics; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D007674:Kidney Diseases / Q000191:economics* / Q000628:therapy; D009934:Organization and Administration; D010530:Peritoneal Dialysis / Q000191:economics*