Making a difference providing equitable renal care globally

In their report, Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala, Moore et al describe a 42-year old indigenous Maya man who loses his job after being diagnosed with complicated diabetes. He later develops renal failure of unknown etiology. The patient originally presents to a non-profit clinic, then goes to a "higher-level laboratory in the regional capital," and finally to "The National Centre for Chronic Renal Disease (UNAERC)" The patient is given two options for renal replacement therapy, either twice-weekly haemodialysis or continuous ambulatory peritoneal dialysis (CAPD). Due to his limited mobility and finances, the patient chose CAPD as management of his renal failure.

Chronic Kidney Disease (CKD) is a common effect of many non-communicable disease processes, including hypertension, diabetes, and iatrogenic causes. The burden of this disease, "is significant and rising." CKD in general, and end-stage renal disease (ESRD) in particular are illnesses which have profound impact on the family, social, economic and psychological well-being of patients. As described by the authors, the patient's wife "cannot hold a regular job…as primary caregiver…. The patient and his family have subsided on donations…as well as meagre wages…. The patient… worries constantly about the future. His chronic diseases have caused him to feel distress, helplessness and shame." The patient is not alone in feeling this way. While studies in the developing world regarding quality of life on dialysis patients are lacking, those that do exist support the psychosocial detriment that dialysis is to many.^[1] According to one patient, "In many ways… dialysis is the end of hope." ^[2] This reveals the importance of a multidisciplinary approach to renal replacement in the developing world, with a special emphasis on social work and mental health services.

CKD and ESRD also target vulnerable populations. The authors speak convincingly of a "sickness-poverty cycle… he became too sick to work, then too poor to pay for quality healthcare and medications and consequently he became even sicker." The inability of patients to access care and the inequity created by the care delivered can be devastating for patients who do not possess social capital to protect themselves. This can include the indigenous Maya in Guatemala, others of poor socioeconomic status in Latin America, or even undocumented immigrants in a country with a well-developed healthcare system, such as the United States. ^[3] Comprehensive, universally accessible healthcare is necessary for the protection of these patients, and may help prevent CKD from transitioning to ESRD. The delivery of this care will be one of the challenges of the future as non-communicable diseases continue to increase in the developing world.

BMJ Case Reports invites authors to submit global health case reports that describe the delivery of renal care for vulnerable patients. These cases could focus on:

-Unique models of delivery in the developing world
-Successful interventions for providing access to vulnerable patients worldwide
-Challenges and complications of renal care in low-resource settings

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at casereports.bmj.com. For more information, review our guidance on how to write a global health case report and look through our online collection.

To read more about renal care globally at BMJ Case Reports, please review:
–Acute peritoneal dialysis in a Jehovah's Witness post laparotomy
–Renal failure: unusual clinical presentation of an isolated intracranial hydatid cyst

To read more about kidney disease globally from other cited sources, please review:

^[1] Awuah KT, Finkelstein SH, Finkelstein FO. Quality of life of chronic kidney disease patients in developing countries. Kidney international supplements. 2013 May 1;3(2):227-9.
^[2] Russ AJ, Shim JK, Kaufman SR. "Is there life on dialysis?": time and aging in a clinically sustained existence. Medical anthropology. 2005 Oct 1;24(4):297-324.
^[3] Campbell GA, Sanoff S, Rosner MH. Care of the undocumented immigrant in the United States with ESRD. American Journal of Kidney Diseases. 2010 Jan 1;55(1):181-91.

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