Considerations on equity in management of end-stage kidney disease in low- and middle-income countries

Wim Van Biesen, Vivekanand Jha, Ali K. Abu-Alfa, Sharon P. Andreoli, Gloria Ashuntantang, Bassam Bernieh, Edwina Brown, Yuqing Chen, Rosanna Coppo, Cecile Couchoud, Brett Cullis, Walter Douthat, Felicia U. Eke, Brenda Hemmelgarn, Fan Fan Hou, Nathan W. Levin, Valerie A. Luyckx, Rachael L. Morton, Mohammed Rafique Moosa, Fliss E.M. MurtaghMarie Richards, Eric Rondeau, Daniel Schneditz, Kamal D. Shah, Vladimir Tesar, Karen Yeates, Guillermo Garcia Garcia

Research output: Contribution to journalReview articlepeer-review

26 Scopus citations


Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and delivery models, and nature of KRT prioritization (transplantation, hemodialysis or peritoneal dialysis, and conservative care). Implementation of KRT programs has the potential to exacerbate inequity unless equity is deliberately addressed. In this review, we summarize discussions on equitable provision of KRT in low- and middle-income countries and suggest areas for future research.

Original languageEnglish
Pages (from-to)e63-e71
JournalKidney International Supplements
Issue number1
StatePublished - Mar 2020


  • end-stage kidney disease
  • equity
  • ethical framework
  • kidney replacement therapy
  • reimbursement
  • social justice


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