Pediatric CRRT in the Developing World Dr Sidharth Kumar Sethi Pediatric Nephrology Kidney and Urology Institute Medanta-The Medicity INDIA.

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Presentation transcript:

Pediatric CRRT in the Developing World Dr Sidharth Kumar Sethi Pediatric Nephrology Kidney and Urology Institute Medanta-The Medicity INDIA

Developed vs Developing 100 countries; 80% of the world population lives here!

Challenges in developing world

Prosperity & Access to RRT

Dialysis Centres (per million) ESRD Incidence

Patients receiving RRT Everyone who needs RRT, gets it!

Receiving RRT as per income

Projections

Healthcare Expenditure

Barriers to CRRT

International Pediatric Dialysis Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Pediatric Nephrologist & pCRRT Availability Pediatricians & Adult Nephrologists primary care givers India and around – 4 centres – <10 Kg- 2 centres International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Trained CRRT Staff Technicians Anticoagulation Heparin Saline International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Cost of RRT care Not insured Out of pocket expenses International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Indirect losses

Extent of financial crisis

Choice of modality: unstable pediatric patients Developing Developed International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Choice of modality in Older children Developing International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Choice of modality in infants with AKI International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Availability of SLED International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Availability of Pediatric sized HD tubings International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

Modality choice in children: India Indian Journal of Nephrology 2012;22:

PD/SLED is lifesaving

IPNA; ISN Support Fellowships ISN Sister Renal Centre Programme Focused Training Courses

Preventable deaths: developing world

Conclusions CRRT in developing world evolving ! Lots to learn and implement Need for resources & training manpower PD/SLED can be life saving, when required! Dialysis Modality Choice and Initiation – Global preferences. McCulloch, Sethi, Xu. ‘Pediatric Kidney Disease’.