1. Pediatric CRRT in the Developing World Dr Sidharth Kumar Sethi Pediatric Nephrology Kidney and Urology Institute Medanta-The Medicity INDIA

2. Developed vs Developing 100 countries; 80% of the world population lives here!

3. Challenges in developing world

4. Prosperity & Access to RRT

5. Dialysis Centres (per million) ESRD Incidence

6. Patients receiving RRT Everyone who needs RRT, gets it!

7. Receiving RRT as per income

8. Projections 2010-2030

9. Healthcare Expenditure

10. Barriers to CRRT

11. International Pediatric Dialysis Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

12. Pediatric Nephrologist & pCRRT Availability Pediatricians & Adult Nephrologists primary care givers India and around – 4 centres – <10 Kg- 2 centres International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

13. Trained CRRT Staff Technicians Anticoagulation Heparin Saline International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

14. Cost of RRT care Not insured Out of pocket expenses International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

16. Indirect losses

17. Extent of financial crisis

18. Choice of modality: unstable pediatric patients Developing Developed International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

19. Choice of modality in Older children Developing International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

20. Choice of modality in infants with AKI International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

21. Availability of SLED International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

22. Availability of Pediatric sized HD tubings International Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

24. Modality choice in children: India Indian Journal of Nephrology 2012;22:121-124

25. PD/SLED is lifesaving

26. IPNA; ISN Support Fellowships ISN Sister Renal Centre Programme Focused Training Courses

27. Preventable deaths: developing world

28. Conclusions CRRT in developing world evolving ! Lots to learn and implement Need for resources & training manpower PD/SLED can be life saving, when required! Dialysis Modality Choice and Initiation – Global preferences. McCulloch, Sethi, Xu. ‘Pediatric Kidney Disease’.