Oral Sorbents in Uremia

Abstract

In late 1981, more than 56,000 Americans were being kept alive, despite irreversible uremia, by maintenance peritoneal or hemodialysis, at an annual governmental expenditure exceeding 1.2 billion dollars. Dialytic therapy, as now practiced, and renal transplantation, from a living or cadaveric donor, extend useful life for years, for most patients. Because of its extraordinary cost, however, approximately three out of four people around the world will have no chance of receiving contemporary uremia therapy should their kidneys fail (1). Extreme variation in availability and quality of health care between industrialized and ‘third world’ nations, is nowhere better illustrated than in the statistics of uremia therapy. Whereas Japan, for example, sustained 251 uremic patients per million population in 1981, Egypt could afford to treat only one per million, and China and India treat less than one per million people (2). Nigeria, at the bottom of the list, with a population of 70 million, has no uremia therapy at all. Texts on modern management of renal insufficiency, therefore, are pertinent, for the time being, to only a minority of a rapidly growing world population.