The Rights of Patients with Chronic Kidney Disease in the World: Legal Perspectives and Challenges in Brazil, India, Portugal, South Africa, and Nigeria.

Clinical Background: Chronic kidney disease (CKD) is a condition that causes important limitations to patients' lives. The limitations imposed as a result of the disease end up hampering the exercise of citizenship by individuals, including work and daily activities. Epidemiology: The prevalence of CKD in Brazil, India, Nigeria, Portugal, and South Africa is, respectively, 5.8-25.2, 13-17.2, 7.8-23.5, 6.1-20.7, and 6.4-17.3%, and is higher among the most disadvantaged populations. Challenges: The present study intends to make an intersection between health sciences, considering the reality faced by the patient with CKD, and the legal perspectives regarding the protective dimension of the right to healthcare and the access of these individuals to a better quality of life. Despite differences in size, population, and human development, there are some similarities among countries in the normative approach regarding the right to healthcare of patients with CKD. The study was developed based on an analysis carried out by legal scholars and specialists from Brazil, India, Portugal, South Africa, and Nigeria. Not only the texts of constitutions and laws were examined, but also how courts interpret and apply them. It was identified that the impact of kidney disease is also associated with human development issues. Adequate access to renal replacement therapy is not always found in the countries examined as well as to kidney transplants. It was observed that the constitutional protection of the right to healthcare is present in some constitutions such as those of Brazil, Portugal, and South Africa. Specific legislation that regulates access to medicines, dialysis, and kidney transplantation was analyzed. Financial aid and right to social assistance and social insurance benefits guaranteed by law are found only in some countries. However, for legal provisions to become effective, it is still necessary to overcome sociocultural and budgetary issues. Prevention and Treatment: Public policies directed to CKD patients, ensuring access to information, preventive measures, and treatment, should be elaborated to answer the increasing demand for renal replacement therapy, including dialysis and transplant.