In February 2017, specialists and early career physicians from six economically developing countries - Cambodia, India, Lao People's Democratic Republic (PDR), Mongolia, Myanmar, and Vietnam - joined specialists from the economically developed country Japan for dialysis training and a symposium entitled “Dialysis Situation in Asian Countries” held at Nipro Corporation's Institute for Medical Practice (iMEP) in Japan.

This article summarizes the situation of dialysis in these six economically developing Asian countries, as presented by specialists at the symposium. The situation in each country is presented in the form of easy-to-read, downloadable infographics, which we hope can be used to stimulate further discussion.

We begin by briefly introducing the concept behind the symposium and how all of the articles in this special publication, “Current Status and Challenges of Dialysis in Asian Countries,” help to build an initial picture about current progress in dialysis and further progress that is needed in the region.

The symposium “Dialysis Situation in Asian Countries” was sponsored and hosted at iMEP as part of Nipro Corporation's mission to support education and training in the field of dialysis. The event was designed to initiate in-depth discussions on the current status and challenges of dialysis in Asia among specialists from the seven countries. The publication “Current Status and Challenges of Dialysis in Asian Countries” is the result of all the valuable discussions that took place.

The concept behind the educational event and resulting publication was for each participating country to (1) present an update on the current situation of dialysis, (2) receive training in and discuss the latest diagnostic and treatment technologies and standards in dialysis, (3) publish valuable clinical information, and (4) ultimately disseminate all of the knowledge acquired at the event for further training and support of healthcare professionals involved in dialysis in Asia.

Through an unrestricted educational grant from Nipro Corporation, the participating specialists received educational support to prepare symposium presentations in English and subsequently to prepare the presented data for reporting in English in a special publication. This educational support was provided independently by ThinkSCIENCE, Inc. (Tokyo, Japan) in the form of medical writing and editing in English as well as explanation of relevant publication ethics. Nipro Corporation had no role in the collection, analysis, selection, and reporting of any data presented at the symposium or in the preparation of the resulting articles for the special publication “Current Status and Challenges of Dialysis in Asian Countries.”

The current status of dialysis in the six economically developing countries are shown in the figures referred to below, which were created independently by the country specialists. The infographics highlight many facts and figures as well as many similar challenges that the countries face (see Fig. 1-6).

Figure 1 (www.karger.com/doi/10.1159/000479579)summarizes the situation in Cambodia, as reported by Dr. Kanitha Sovann. In addition to a limited number of facilities providing dialysis and a shortage of nephrologists in the country, patients often miss treatment sessions and checkups because of the financial burden of paying for the treatment themselves. For patients living in more rural areas, where there are currently no treatment facilities, this burden is compounded by paying transportation and accommodation costs in order to receive treatment.

Fig. 1

Sovann, Blood Purif 2017;44(suppl 1):22-25.

Fig. 1

Sovann, Blood Purif 2017;44(suppl 1):22-25.

Close modal

In India, too, there is a high financial burden on patients (Fig. 2; www.karger.com/doi/10.1159/000479613). As reported by Dr. Georgi Abraham et al., there is little insurance coverage for dialysis at present and the private sector provides most of the dialysis care available. The current management of most patients with stage 4 or 5 chronic kidney disease (CKD) involves conservative or palliative treatment, with most CKD stage 5 patients not receiving any form of renal replacement therapy.

Fig. 2

Abraham et al., Blood Purif 2017;44(suppl 1):26-30.

Fig. 2

Abraham et al., Blood Purif 2017;44(suppl 1):26-30.

Close modal

In Lao PDR, as reported by Dr. Phanekham Souvannamethy, there are a limited number of facilities serving around 5,000 hemodialysis (HD) patients (Fig. 3; www.karger.com/doi/10.1159/000479615), and HD is not covered by insurance at this time. As in the other economically developing countries across the region, this places great financial burden on the patients and results in irregular treatment. Among the other challenges faced, there are no local technicians to repair dialysis machines, and water systems are not regularly inspected. Such obstacles were also reported by other Asian countries.

Fig. 3

Souvannamethy, Blood Purif 2017;44(suppl 1):31-34.

Fig. 3

Souvannamethy, Blood Purif 2017;44(suppl 1):31-34.

Close modal

In Mongolia, Dr. Saruultuvshin Adiya et al. reported there is insufficient government financing of dialysis (Fig. 4; www.karger.com/doi/10.1159/000479616), and patients receive only 4-8 h of HD per week because of the limited number of machines available. However, the number of machines is gradually increasing in state hospitals. Health insurance is available, but does not cover erythropoietin, phosphate binders, vitamin D, or calcimimetic preparations.

Fig. 4

Adiya et al., Blood Purif 2017;44(suppl 1):35-40.

Fig. 4

Adiya et al., Blood Purif 2017;44(suppl 1):35-40.

Close modal

Myanmar, like many of the countries in Asia, shows disparity in the provision of HD treatment between the capital city and other areas. Dr. Yi Yi Khine reported that financial support of the health sector has improved recently, but out-of-pocket expenditure remains high (Fig. 5; www.karger.com/doi/10.1159/000479618). As in some of the other Asian countries, there is a shortage of nephrologists, insufficient health education for patients, and a lack of clinical engineers to conduct maintenance checks of equipment. Like in Lao PDR, there is currently no national association for kidney disease that could help foster advancements in HD.

Fig. 5

Khine, Blood Purif 2017;44(suppl 1):41-45.

Fig. 5

Khine, Blood Purif 2017;44(suppl 1):41-45.

Close modal

In Vietnam, as reported by Dr. Pham Van Bui et al., all HD facilities are overloaded, and there is a shortage of qualified healthcare providers. HD is not always affordable, even though it is covered by health insurance, because patients pay additional treatment costs at many facilities (Fig. 6; www.karger.com/doi/10.1159/000479619). While modern dialysis machines are available, the water quality for dialysis is questionable and dialyzers are reused many times.

Fig. 6

Bui et al., Blood Purif 2017;44(suppl 1):46-51.

Fig. 6

Bui et al., Blood Purif 2017;44(suppl 1):46-51.

Close modal

It is hoped that the important and valuable information shown in this article's figures and in the other articles in this special publication will serve multiple purposes, including (1) providing a benchmark against which future progress in dialysis can be evaluated in Asia, (2) furthering education about dialysis in the region, and (3) prompting more discussion of the need for dialysis in the region and how such needs can best be met.

The author thanks Caryn Jones of ThinkSCIENCE Inc., Japan, for assistance with writing this article. Nipro Corporation is grateful to Richard Bradly Harris and Dr. Florence Orim of ThinkSCIENCE, Inc. for creating the figures in this article, which were prepared as country status infographics independently with the authors. Nipro Corporation is grateful to Karger Publishers - Editorial Division Asia (Japan) and ThinkSCIENCE, Inc. for their highly professional coordination and realization of this unique educational and informational concept, which was completed in accordance with international standards and guidelines and meets the compliance policy of Nipro Corporation.

Toshiaki Masuda, Managing Director, Nipro Corporation, Japan

Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.