The Role of Economies of Scale in the Cost of Dialysis across the World: a Macroeconomic Perspective

BACKGROUND: The treatment of chronic kidney disease through dialysis is a considerable expense in most health systems. The two chief methods of providing dialysis, haemodialysis (HD) and peritoneal dialysis (PD) have significant differences in cost composition and factors of production. The aim of this article is to identify and quantify the macroeconomic variables that influence the relative cost of such modalities across different countries. METHODS: From previously published literature, we extracted the estimates of HD/PD cost ratios in a total of 46 countries. We conducted a multivariate regression analysis using the estimated HD/PD cost ratio in each country, with several country level indicators as explanatory variables. We found a strong statistical effect of the following variables on the HD/PD cost ratio: country's level of development, economies of scale and percentage of private health-care expenditure. RESULTS: The statistical effects on HD/PD ratio by local manufacturing and relaxed import regulation of PD equipment were calculated and were found to be very significant. CONCLUSIONS: it is possible for a country to still reap the benefits of economies of scale in provision of PD, even in the absence of a large enough market to make local production of PD equipment feasible in that country

Wearable artificial kidney and wearable ultrafiltration device vascular access-future directions

International audienceIn this article considered the concept of water tourism. The water tourism as a special type of recreation have been studied. The conditions for the development of water tourism in the South-East part of the Republic of Sakha (Yakutia) are described. Scientific and methodological foundations have been developed for creating digital maps of water tourism. The structure of GIS for water tourism is proposed.В данной статье рассмотрено понятие о водном туризме. Изучены особенности водного туризма как особого вида рекреации. Описаны условия развития водного туризма на Юго-Востоке Республики Саха (Якутия). Разработаны научно-методические основы для создания электронных карт водного туризма. Предложена структура ГИС для водного туризма

Wearable artificial kidney and wearable ultrafiltration device vascular access-future directions

Background: Since 2005, three human clinical trials have been performed with the Wearable Artificial Kidney (WAK) and Wearable Ultrafiltration (WUF) device. The lack of an adequate vascular access (VA) has been pointed out as the main limitation to their implementation. Based on the current level of understanding, we will make the first conceptual proposal of an adequate VA suitable for the WAK and the WUF. Methods: All the literature related to WAK and WUF was reviewed. Based on eight main publications the VA major characteristics were defined: a mean blood flow of 100 mL/min; the capability to allow prolonged and frequent dialysis treatments, without interfering in activities of daily living (ADL); safe and convenient connection/disconnection systems; reduced risk of biofilm formation and coagulation; high biocompatibility. A research was done in order to answer to each necessary technological prerequisites. Results: The use of a device similar to a CVC with a 5Fr lumen, seems to be the most feasible option. Totally subcutaneous port devices, like the LifeSite(R) or Dialock (R) systems can be a solution to allow WAK or WUF to operate continuously while patients carry out their ADL. Recently, macromolecules that reduce the risk of thrombosis and infection and are integrated into a CVC have been developed and have the capability of overcoming these major limitations. Conclusion: With an adequate VA, portable HD devices can be acceptable options to address several unmet clinical needs of HD patients.info:eu-repo/semantics/publishedVersio