ABSTRACT
Background: The epidemic of non-communicable disease in the Compact nations of the US Affiliated Pacific Islands and the associated renal complications drive the demand for hemodialysis. Limited healthcare budgets and a lack of trained human health resources in these areas make hemodialysis a challenging undertaking that may require significant sacrifices in competing health care priorities. Methods: Two nephrologists who developed hemodialysis in the US Affiliated Pacific Islands provide its history. Cost estimates of hemodialysis for the Compact nations are collected from a 2014 hemodialysis feasibility report. The experiences and outcomes of current hemodialysis centers in the United States and other island nations provide a framework by which to assess the potential benefit and impact of hemodialysis in the Compact nations. Discussion: A consideration of how and why different stakeholders value hemodialysis will be crucial because they will drive the public's response to the institutionalization of any new intervention or the cessation of any existing intervention like hemodialysis. Conclusion: Updated cost estimates for dialysis clinics and data on renal disease rates in the Compact nations will be necessary to make informed decisions about hemodialysis in the current health systems. In the meantime, it is essential to enhance current medical interventions and public health strategies to prevent kidney disease and decrease the risks for kidney failure. Such preventive interventions must be culturally appropriate, effective, cost-efficient, and sustainable in the unique context of the Pacific.
Subject(s)
Renal Dialysis/history , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , History, 20th Century , History, 21st Century , Humans , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/therapy , Pacific Islands , Renal Dialysis/economics , Renal Dialysis/methodsABSTRACT
A 9-year-old boy in Hawai'i presented with bleeding and thrombocytopenia and was subsequently found to have post-streptococcal glomerulonephritis. He recovered completely with intravenous immune globulin, antibiotics, short-term antihypertensive therapy, and supportive management. This case was similar to the 5 cases previously reported in the literature, with the exception that steroids were not used as the primary immune-modulating therapy.
