Challenges in Diagnosis and Management of Glomerular Disease in Resource-Limited Settings

Glomerular diseases are the leading drivers of nondiabetic chronic kidney disease disability-adjusted life years in resource-limited countries. Proper diagnosis and treatment relies on resources including kidney biopsy, ancillary testing, and access to evidence-based therapies. We conducted a cross-...

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Bibliographic Details
Published in:	Kidney international reports Vol. 7; no. 10; pp. 2141 - 2149
Main Authors:	Ramachandran, Raja, Sulaiman, Shabna, Chauhan, Prabhat, Ulasi, Ifeoma, Onu, Ugochi, Villaneuva, Russell, Alam, Muhammad Rafiqul, Akhtar, Fazal, Vincent, Lloyd, Aulakh, Gurmehar S., Sutranto, Aida Lydia, Zakharova, Elena, Jha, Vivekanand
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-10-2022 Elsevier
Subjects:	Africa Asia Clinical Research glomerular diseases glomerulonephritis kidney biopsy low and middle income countries glomerular diseases kidney biopsy glomerulonephritis Asia low and middle income countries Africa
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Summary:	Glomerular diseases are the leading drivers of nondiabetic chronic kidney disease disability-adjusted life years in resource-limited countries. Proper diagnosis and treatment relies on resources including kidney biopsy, ancillary testing, and access to evidence-based therapies. We conducted a cross-sectional internet-based survey cascaded through society mailing lists among nephrologists in countries of Asia, Africa, and Eastern Europe. We collected the data on respondent demographics, their ability to perform and appropriately interpret a kidney biopsy, and their access to complementary investigations and treatment practices. A total of 298 kidney care specialists from 33 countries (53.3% from Asia and 44.6% from Africa; 64% from academic or university hospitals) participated in the survey. Of these specialists, 85% performed kidney biopsy. About 61% of the respondents could not obtain a kidney biopsy in more than 50% of patients with suspected glomerular disease. About 43% of the respondents from Africa had access to only light microscopy. Overall, the inability to undertake and fully evaluate a biopsy and perform ancillary investigations were more profound in Africa than in Asia. Overall, 59% of participants reported that more than 75% of their patients meet the cost of diagnosis and treatment by out-of-pocket payments. Empirical use of immunosuppression was higher in Africa than in Asia. The main barriers for diagnosis and treatment included delayed presentation, incomplete diagnostic work-up, and high cost of treatment. Major system-level barriers impede the implementation of guideline-driven approaches for diagnosis and treatment of patients with glomerular disease in resource-limited countries.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2468-0249 2468-0249
DOI:	10.1016/j.ekir.2022.07.002