Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey

Abstract

Objective To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. Design International cross sectional survey. Setting International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. Participants Key stakeholders identified by ISN’s national and regional leaders. Main outcome measures Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. Results Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world’s population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management—namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. Conclusions These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.

Strategic plan for integrated care of patients with kidney failure

“…The quality of dialysis delivered to patients varies between different regions, different countries, and different facilities across the world. 19,20 Safe and effective delivery of dialysis is especially challenging in LIC and LMIC. Limited Aim.…”

“…However, availability is not synonymous with uniform accessibility and/or uniform adherence to quality standards along with advocacy. 20 Lack of skilled workforce (nephrologists, nurses, and dialysis technicians) is a major barrier in providing optimal care of patients with kidney failure in resource-limited settings. In the absence of standards or regulatory oversight, the quality of training and the competencies of personnel engaged in dialysis delivery remain highly variable.…”

Advocacy for renal replacement therapy: the role of renal registries

“…The Global Kidney Health Atlas Project, part of the Closing the Gaps initiative led by the International Society of Nephrology, indicates that the health systems of many countries face substantial challenges in closing the large gaps reported to exist today in meeting the health needs of the people with acute kidney injury (AKI) and chronic kidney disease (CKD) around the world [ 2 , 3 ].…”

“…However, the Global Kidney Health Atlas Project has reported the limited availability of reliable surveillance systems for both AKI and CKD across countries and regions. This lack is a major impediment to the design and implementation of effective interventions to close recognized gaps in infrastructures and services [ 2 , 3 , 16 ].…”

Worldwide Disparity in the Relation Between CKD Prevalence and Kidney Failure Risk

“…The Global Kidney Health Atlas, led by the International Society of Nephrology (ISN), recently provided a comprehensive overview of the capacity of health systems to deliver care for kidney failure worldwide. (10) This capacity remains a major determinant of the variations observed in KRT incidence in low-and middle-income countries. Large variations in KRT incidence may also exist, however, across countries where access to KRT is not restricted.…”