End-stage renal disease care in South Asia: demographics, economics, and opportunities.

The epidemiologies of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in South Asia are not well defined. Small studies suggest that there is a predominant affliction of younger individuals and presence of risk factors beyond the traditional ones like diabetes and hypertension. The underprivileged poor who do not have access to healthcare facilities are affected disproportionately, present late, and lack means to afford treatment. Renal replacement therapy (RRT) is not widely available and is mostly delivered through expensive private-sector hospitals. There are no CKD detection or prevention programs, and reimbursement for RRT is not available to most people. As more patients present for treatment, the limited infrastructure will come under further strain. There is an urgent need to identify unique preventable risk factors related to causation and progression of CKD and to institute appropriate care. South Asian countries need local solutions by tapping into local resources as well as innovating and coordinating so that a comprehensive care plan can be put in place. New models of integrated noncommunicable disease care delivery through manpower restructuring and technological support will help reduce the disease burden.