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

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


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. Murtagh

Marie Richards

Eric Rondeau

Daniel Schneditz

Kamal D. Shah

Vladimir Tesar

Karen Yeates

Guillermo Garcia Garcia



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.


Van Biesen, W., Jha, V., Abu-Alfa, A. K., Andreoli, S. P., Ashuntantang, G., Bernieh, B., …Garcia Garcia, G. (2020). Considerations on equity in management of end-stage kidney disease in low- and middle-income countries. Kidney International Supplements, 10(1), e63-e71.

Journal Article Type Article
Acceptance Date Nov 7, 2019
Online Publication Date Feb 19, 2020
Publication Date 2020-03
Deposit Date Feb 23, 2020
Publicly Available Date Feb 20, 2021
Journal Kidney International Supplements
Print ISSN 2157-1716
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 10
Issue 1
Pages e63-e71
Keywords Nephrology; end-stage kidney disease; equity; ethical framework; kidney replacement therapy; reimbursement; social justice
Public URL