Inequities in Pediatric Nephrology: Disparities in Children's Kidney Health and Access to Care

Abstract

Pediatric kidney diseases have a lower prevalence compared to adults but contribute to the high global burden of non-communicable diseases. Children with kidney disease (congenital or acquired, acute kidney injury, or chronic kidney disease) encounter unfair disparities in morbidity, burdens, and clinical outcomes due to sociodemographic and economic inequalities rather than true biological differences. Inequity occurs in the global distribution of disease burden, in the access to adequate primary care and specialized pediatric nephrology services, in disease data equity, and in participation in clinical research. The inequity in access to renal replacement therapy is especially severe, resulting in high mortality rates for children with kidney failure in low and low-middle-income countries. The causes for inequity in pediatric kidney diseases begin at the level of the individual child and their family circumstances, extend to the resources and health literacy of a community, and finally result from disparity in national wealth and a country's health care investment and allocation policies for children. Several actions to mitigate these inequities can be successfully implemented by health care providers and society at large. Ultimately, it is the moral obligation of the global nephrology community to advocate for the rights and well-being of every child with kidney disease.