While home-based dialysis treatments are on the rise across the globe, developed countries seem to be opting for more hospital visits, which could place the developing world at the centre of research innovations surrounding kidney disease treatment. Or so believes Western professor Arsh Jain, Department of Medicine, Department of Epidemiology and Biostatistics.
“There’s a billion people in China; there’s a billion people in India,” said Jain, noting the developing world numbers are rising in both home-based and clinical-based treatment from the increase in diagnosis. “So those people will be a large market at some point and will probably drive a lot of what happens in terms of research innovations.”
Dialysis treatments for kidney failure come in two forms: peritoneal dialysis, usually done at home, and hemodialysis, predominantly clinic-based.
With peritoneal dialysis, fluids are pumped into and removed from the stomach each night (while sleeping, for example) to collect waste from the blood. During hemodialysis, the more well-known treatment done in hospital, blood is removed and purified by a machine before being returned to the body.
The majority of people with kidney disease find themselves on a waiting list, Jain said, with approximately 2 million patients in the world receiving some sort of dialysis treatment.
In a recently released study, Jain explored peritoneal dialysis use, comparing developed countries with developing countries. What he discovered is informing his belief in a shift in innovation.
In comparing the use of peritoneal dialysis to hemodialysis, Jain analyzed records from 1997-2008 in 130 countries and unearthed some interesting numbers.
In 2008, there were approximately 196,000 peritoneal dialysis patients worldwide, representing 11 per cent of the dialysis population. In total, 59 per cent of those patients were treated in developing countries and 41 per cent in developed countries.
Over the 12 years of the study, the number of peritoneal dialysis patients increased by 24.9 patients per million population in developing countries and only 21.8 per million in developed.
The proportion of all dialysis patients treated with peritoneal dialysis did not change in developing countries, but significantly declined in developed countries by 5.3 per cent.
“The vast majority of patients in both hemodialysis and peritoneal are in the developed world. But the developing world represents a much larger proportion of the world, and is growing at exponential rates as compared to the developed world,” said Jain, whose study appeared in a recent issue of the Journal of the American Society Nephrology. “The growth rate in the developing world is growing faster (2.5 times) than it is in the developed world. For countries like Canada, where the home-based therapy is cheaper, you would think we’d be having more of a push to get these people home.”
Peritoneal dialysis is also half the cost of the clinic-based procedure, Jain said, plus it takes less of a physical toll on the body. But over the last decade, its use in Canada is waning, with patients flocking to dialysis units in hospitals, despite the fact studies have shown peritoneal dialysis is associated with a better quality of life.
“I hope in Canada that we do have a stronger push to get people home for peritoneal and some home-based hemodialysis,” Jain said. “Quality of life is better; it just makes sense. It can be up to half as expensive to treat at home. We are also able to provide support home care people to assist patients.”
As far as future research is concerned, while optimistic, Jain said there needs to be assurances as to the ability to transfer the findings into patient care back home.
“From living in Canada, we would want to make sure the developments that happen in the field would be good for our delivery in Canada,” Jain said. “It’s great that these other countries will be driving (research) and more people utilizing these things and there will be more research done. As a company, you need to market to the biggest consumer, so you’re not going to market to Canada, you’re going to market to China and India and places like that.”
While it will take another decade for new statistics to populate, Jain plans to follow up on his latest study and is hopeful for an increase in the use registries of kidney patients in other countries, to allow for better tracking of patients.