The affordable dialysis project


End stage kidney disease (ESKD) occurs when kidney function has deteriorated to the point that dialysis or a kidney transplant is required to stay alive.  Research undertaken by the George Institute published in the Lancet in March 2015 shows that the burden of ESKD around the world is growing, and that most of the expected increase will be in low and middle income countries (LMIC) (link to ref 1) 

In the same study it was estimated that 2.2 million people were on dialysis around the world in 2014, the most recent year for which global figures were available.   Up to 7 million additional patients were in need of dialysis but unable to obtain access, usually for financial reasons.  These patients would all have died, and it can be reasonably assumed that similar numbers will die each year for the same reason. 

Dialysis is a safe and effective treatment for ESKD, but it is expensive, well beyond the means of the average patient and their families.  For this reason, in wealthy countries the cost of dialysis treatment is borne by the national health care system.  In most LMIC there is no national system for paying for dialysis, and often patients and their families attempt to bear the cost.  This can create an economic catastrophe for the entire family (link to ref 3)


  1. Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, Zhao M, Lv J, Garg AX, Knight JF, Rodgers A, Gallagher M, Kotwal S, Cass A, Perkovic V.  Global access to treatment for end stage kidney disease.   Lancet 2015.  Published Online March 13, 2015.
  2. Knight JF, Perkovic V.  The affordable dialysis prize steams ahead.  Lancet 2016, 387, 1040 
  3. Jha V, Martin DE, Bargman JM, Davies S, Feehally J, Finkelstein F, Harris D, Misra M, Remuzzi G, Levin A for the International Society of Nephrology Ethical Dialysis Task Force.  Ethical issues in dialysis therapy.  Lancet 2017, 389, 1851-6.