Issues of Renal Replacement Therapy in Elders Living Low-Income African Countries

AUTHORS

Sidy Seck 1 , *

1 Faculty of Health Sciences, University Gaston Berger, Saint-Louis, Senegal

How to Cite: Seck S. Issues of Renal Replacement Therapy in Elders Living Low-Income African Countries, Nephro-Urol Mon. 2012 ; 4(4):648-649. doi: 10.5812/numonthly.7077.

ARTICLE INFORMATION

Nephro-Urology Monthly: 4 (4); 648-649
Published Online: September 24, 2012
Article Type: Letter
Received: July 6, 2012
Revised: July 11, 2012
Accepted: July 17, 2012
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Keywords

Renal Replacement Threrapy Renal Dialysis Africa South of the Sahara

Copyright © 2012, Nephrology and Urology Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Dear Editor,

We read with interest the article by Smyth A about dialysis indications and the modalities of RRT in elderly patients (1). We would herein underline the particular situation in resource limited areas like sub-Saharan Africa where dialysis access is still very poor and nephrologists have often to make a selection among the growing number of and end-stage renal disease (ESRD) patients who need dialysis (2). We recently reported a high prevalence of chronic kidney disease (CKD) (10.7%) in black African patients aged ≥ 60 years with more than half of them presenting ESRD and having no access to renal replacement therapy (RRT) (3). So discussing indications and dialysis methods may appear as superfluous in a context of few dialysis facilities where elderly patients are in competition with young adults and children who are more likely to take profits from dialysis treatment. In this article, authors recommend to balance short-term RRT survival benefit (hemodialysis or peritoneal dialysis) with possible evitable co-morbidities and unnecessary medicalization (1). We agree with the general rule of proposing dialysis to all ESRD patients regardless of their age but for nephrologists working in countries with poor dialysis access, we think that conservative multidisciplinary management should be encouraged as a socio-culturally and medically efficient alternative for elders with ESRD specially if they have co-morbidities (4, 5). Cohort studies comparing RRT and conservative therapy in elders living resource-limited countries should be performed to precise dialysis indications in these populations.

Footnotes

References

  • 1.

    Smyth A. End-Stage Renal Disease and Renal Replacement Therapy in Older Patients. Nephro-Urol Mon. 2012; 4(2) : 425 -30 [DOI]

  • 2.

    Kher V. End-stage renal disease in developing countries. Kidney Int. 2002; 62(1) : 350 -62 [DOI][PubMed]

  • 3.

    Seck SM. Epidemiological patterns of chronic kidney disease in black African elders: a retrospective study in West Africa. Saudi J Kidney Dis Transplant. 2012;

  • 4.

    Carson RC, Juszczak M, Davenport A, Burns A. Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol. 2009; 4(10) : 1611 -9 [DOI][PubMed]

  • 5.

    Brown EA, Johansson L. Epidemiology and management of endstage renal disease in the elderly. Nat Rev Nephrol. 2011; 7(10) : 591 -8 [DOI][PubMed]

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