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The management of end-stage renal disease in underdeveloped countries: a moral and an economic problem.

There are major problems in providing care for children with end-stage renal failure in underdeveloped countries. It is difficult to employ key workers such as dietitians and social workers because of low pay and other demands for their services. The poor pay of physicians is also a problem and few can afford to devote the time necessary to care adequately for chronically disabled children. In Chile it has not been possible to develop comprehensive kidney failure centres for children. Continuous ambulatory peritoneal dialysis has not been encouraged due to the socio-economic and hygienic conditions of the population but isolated intermittent dialysis has been provided. Transplantation has been restricted due to the shortage of cadaver kidneys but a number of children maintained on hospital intermittent chronic peritoneal dialysis have been transplanted successfully. We believe that underdeveloped countries should develop clear programmes for the treatment of chronic renal failure and in addition initiate screening for renal diseases in the population so that early detection of renal disease, for instance in relation to urinary tract infection, can prevent progression to renal failure.