Pediatric CRRT in the Developing World Dr Sidharth

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 2010 -2030

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 & p. CRRT 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 Developed 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 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: Indian Journal of Nephrology 2012; 22: 121 -124

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. Mc. Culloch, Sethi, Xu. ‘Pediatric Kidney Disease’.