Accessibility and Affordability Issues for Renal Replacement Therapy Remain Challenges in Resource-Limited Healthcare Settings: A Case Report and Critique of Literature for Chronic Kidney and End-Stage Renal Disease

Abstract

Chronic kidney disease (CKD) continues to be a global public health problem. Globally, the prevalence of CKD is approximately 8–16% in the general population. Most patients with CKD advance to kidney failure and require dialysis or kidney transplantation. Screening for CKD, diagnosing CKD, treating CKD and its consequences to stop its progression, and renal replacement therapy (RRT) are all parts of comprehensive CKD care. A 28-year-old male presented with complaints of awareness of his heart beating, abdomen and lower limb swelling, and generalised body weakness for 2 days. His blood pressure was 222/147 mmHg on admission day. Six days post-admission, he displayed violent chest pain and dyspnoea, along with profound generalised body swelling. Laboratory studies revealed creatinine of 22.49 mg/dL (0.6–1.1), urea of 236.5 mg/dL (10.0–50), albumin of 2.15 mg/dL (3.8–5.1), potassium of 7.19 mmol/L (3.5–5.5), and haemoglobin of 6.2 g/dL (8.0–17.0). The diagnoses of uremic pericarditis, pulmonary oedema, hyperkalaemia, hypertensive emergency, and normochromic anaemia secondary to end-stage renal diseases were made. He qualified for the RRT. CKD is a serious, non-communicable disease that is commonly encountered in clinical practice in both developed and developing countries and needs the utmost attention. RRT is crucial for comprehensive CKD management; however, in resource-limited healthcare settings, RRT is non-accessible and non-affordable. The lack of RRT marks the mistreatment of patients with renal diseases by the global healthcare system. The author calls for designing new strategies that aim to ensure equitable accessibility and affordability for RRT globally.