Chronic kidney disease in Sri Lanka: Health systems challenges of patients on hemodialysis.

Chronic kidney disease has now attained epidemic proportions, placing a significant strain on Sri Lanka's healthcare system. The North Central Province of Sri Lanka has been afflicted by this disease for decades, confronting multiple challenges. Hemodialysis is the primary form of renal replacement therapy available to end-stage renal disease patients in Sri Lanka. Providing hemodialysis sessions free of cost in the government health sector comes with major costs on the healthcare system. As a country with a low-to-middle income status undergoing through reeling economic crisis, providing free healthcare in government hospitals and increasing the capacity and quality of treatment facilities for the growing number of patients with chronic kidney disease will remain a major challenge for the coming decade. The high cost for a single dialysis session, lack of resources and workforce to meet demand, occupational barriers of patients, and the economic burdens including out-of-pocket expenditures significant barriers in achieving quality treatment sessions and the quality of life of patients. In addition, the absence of a consistent screening program has contributed to the progression of the disease ending up requiring renal replacement therapy. This article suggests potential strategies that can be implemented to mitigate the aforementioned problems and enhance the overall health, quality of life, and survival of patients with chronic kidney disease and those who receive hemodialysis.