[Collapsed Pediatric Care]⑤The Only Pediatric Dialysis Unit Nationwide: Why It Can't Be Established in Regional Areas

Only About 60 Pediatric Dialysis Patients Nationwide
Maintaining a "High-Difficulty, Low-Compensation" Specialty Is a Burden
Concentrating Medical Staff in One Center Is the Most Efficient Way to Build a Specialized Care System

Editor's NoteAlthough there are expectations that the residents who left hospitals a year and a half ago in protest against the expansion of medical school enrollments last February will resume their training, the situation in essential departments dealing with critical and emergency patients remains precarious. In particular, the field of pediatrics is facing a shortage of applicants for residency due to low birth rates, an unreasonable fee structure, and increasing legal risks, while existing specialists are leaving the field. As regional disparities in medical services widen, the care system for sudden pediatric emergencies and severe pediatric diseases requiring specialized intensive treatment is also being shaken. With fewer children being born and even fewer doctors to care for them, the situation is dire. Asia Economy will examine the current state and future directions of the pediatric medical system in a six-part series.

During the peak of the heatwave last month, four-year-old Minjun (alias), who lives in Gijang, Busan, was led by his mother to board a KTX train to Seoul early in the morning. Two days earlier, blood test results from a nearby hospital showed concerning levels of potassium and creatinine, among other indicators, leading to an urgent decision for hospitalization. Carrying a large backpack, a small suitcase in one hand, and holding Minjun's hand with the other, his mother traveled from Gijang to Busan Station by car, then from Busan Station to Seoul Station by KTX, and finally from Seoul Station to Hyehwa Station, where Seoul National University Hospital is located, by subway. The entire journey took five hours.

Four-year-old Minjun (alias), who is suffering from kidney disease, and his mother, his guardian, are traveling from Busan Station to Seoul Station by KTX to be admitted to Seoul National University Hospital. Photo by Jo Yongjun

When Minjun was two months old, he suddenly developed symptoms of anemia and was admitted to Yangsan Busan National University Hospital. Despite undergoing various tests, no clear cause was found, and a rare disease was suspected. During this period, his liver and kidneys deteriorated, and by six months old, he required dialysis. The hospital in Busan said there was nothing more they could do and recommended transferring him to a larger hospital in Seoul. With no other options, Minjun was admitted to Seoul National University Hospital, where he began intravenous treatment and peritoneal dialysis. Seoul National University Hospital operates the only pediatric-dedicated artificial kidney (dialysis) unit in Korea, providing extensive clinical experience and top-level care for pediatric kidney diseases. Currently, Minjun receives peritoneal dialysis at home every night while he sleeps, but once a month, he must visit Seoul National University Hospital for a comprehensive health check and medication to prevent electrolyte imbalances caused by dialysis.

Dialysis, which the guardian must manage entirely, is already challenging, but a bigger problem is that even a minor cold or gastroenteritis can lead to an emergency situation for the child. In Minjun's case, even when receiving a prescription for a cold from a local pediatrician, the prescription must be sent to the Seoul National University Hospital dialysis unit to confirm whether the medication is safe for use. Last year, when he suddenly developed a fever and seizures, his family could not find a tertiary hospital emergency room in Busan that would accept a pediatric patient. Paramedics even considered sending a helicopter, but fortunately, Minjun received emergency care at a hospital and was able to be admitted to Seoul National University Hospital the next day. Not only emergencies, but also complications related to dialysis, developmental issues, and genetic disease assessments require ongoing monitoring and related specialist care, which is only feasible at a hospital like Seoul National University Hospital where multiple specialties are available.

Minjun's mother said, "This hospital has the best medical staff in pediatric dialysis and nephrology, the largest number of patients, and is connected with world-class hospitals, so even though it's difficult, we have no choice but to keep coming to Seoul for treatment. As a parent, even if a new pediatric nephrology department opened in Busan right now, I would still choose the more systematically equipped hospital in Seoul."

It is realistically impossible for every hospital nationwide to operate subspecialty departments and employ specialists for the care of critically ill pediatric patients. This is especially true for cases like pediatric dialysis, where there are few patients but intensive and closely managed care is needed. Currently, there are about 60 children nationwide who require dialysis due to chronic kidney disease, and only a handful of hospitals outside Seoul's five major hospitals-such as Kyungpook National University Hospital, Chonnam National University Hospital, and Jeju National University Hospital-treat these pediatric patients.

The small number of pediatric nephrology hospitals is due to the fact that it is a "high-difficulty, high-risk" specialty but also "low-reward." Kang Heekyung, a professor of pediatrics at Seoul National University Hospital, said on August 27, "Dialysis is more difficult in children than adults because of their smaller bodies, the higher risk of complications such as infections, and the significant costs involved in securing pediatric specialists, facilities, and equipment. However, the number of patients is small, and there is insufficient compensation or appropriate fees, so hospitals are reluctant to establish such departments." She added that while it is inconvenient and unfortunate for patients to travel long hours from their regions to large cities like Seoul for treatment, it is simply not feasible to have pediatric nephrology departments in every hospital.

The best approach is to concentrate medical staff in specialized hospitals within each region to make the most effective use of limited resources, and to ensure that in emergencies, affiliated hospitals in each area can respond appropriately. For example, in the Busan-Gyeongnam region, one hospital could focus on pediatric nephrology while another could concentrate on pediatric hematology and oncology, thus creating a system that provides specialized medical services without gaps. By centralizing medical personnel and equipment in regional hubs rather than dispersing them nationwide, operational efficiency is improved. When patients are also concentrated in one hospital, clinical information and case studies can be more quickly translated into research, and there are more opportunities to participate in clinical trials or receive new drugs and treatments.

Kim Hyeri, a professor of pediatric oncology and hematology at Asan Medical Center, explained, "In the Netherlands, seven pediatric cancer centers nationwide were consolidated into one in 2018, bringing together hundreds of researchers and medical professionals in one place to develop and directly apply new treatments, resulting in improved survival rates and treatment outcomes." Currently, all approximately 600 pediatric cancer patients diagnosed annually in the Netherlands are admitted with their guardians to the Princess Maxima Center for Pediatric Oncology, where they receive treatment as well as systematic education (schooling), psychological counseling, and family support during their care.