Nephrology Dialysis Transplantation

Irish, Georgina; Caskey, Fergus J; Davids, M Razeen; Tonelli, Marcello; Yang, Chih-Wei; Arruebo, Silvia; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Ye, Feng; Okpechi, Ikechi G; Bello, Aminu K; Johnson, David W

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae127pmid: 39235201

ABSTRACTBackgroundData monitoring and surveillance systems are the cornerstone for governance and regulation, planning, and policy development for chronic disease care. Our study aims to evaluate health systems capacity for data monitoring and surveillance for kidney care.MethodsWe leveraged data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), an international survey of stakeholders (clinicians, policymakers and patient advocates) from 167 countries conducted between July and September 2022. ISN-GKHA contains data on availability and types of kidney registries, the spectrum of their coverage, as well as data on national policies for kidney disease identification.ResultsOverall, 167 countries responded to the survey, representing 97.4% of the global population. Information systems in forms of registries for dialysis care were available in 63% (n = 102/162) of countries, followed by kidney transplant registries (58%; n = 94/162), and registries for non-dialysis chronic kidney disease (19%; n = 31/162) and acute kidney injury (9%; n = 14/162). Participation in dialysis registries was mandatory in 57% (n = 58) of countries; however, in more than half of countries in Africa (58%; n = 7), Eastern and Central Europe (67%; n = 10), and South Asia (100%; n = 2), participation was voluntary. The least-reported performance measures in dialysis registries were hospitalization (36%; n = 37) and quality of life (24%; n = 24).ConclusionsThe variability of health information systems and early identification systems for kidney disease across countries and world regions warrants a global framework for prioritizing the development of these systems.

Cho, Yeoungjee; Cullis, Brett; Ethier, Isabelle; Htay, Htay; Jha, Vivekanand; Arruebo, Silvia; Caskey, Fergus J; Damster, Sandrine; Donner, Jo-Ann; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G; Bello, Aminu K; Johnson, David W

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae130pmid: 39235200

ABSTRACTBackgroundWorldwide, the uptake of peritoneal dialysis (PD) compared with hemodialysis remains limited. This study assessed organizational structures, availability, accessibility, affordability and quality of PD worldwide.MethodsThis cross-sectional study relied on data from kidney registries as well as survey data from stakeholders (clinicians, policymakers and advocates for people living with kidney disease) from countries affiliated with the International Society of Nephrology (ISN) from July to September 2022.ResultsOverall, 167 countries participated in the survey. PD was available in 79% of countries with a median global prevalence of 21.0 [interquartile range (IQR) 1.5–62.4] per million population (pmp). High-income countries (HICs) had an 80-fold higher prevalence of PD than low-income countries (LICs) (56.2 pmp vs 0.7 pmp). In 53% of countries, adults had greater PD access than children. Only 29% of countries used public funding (and free) reimbursement for PD with Oceania and South East Asia (6%), Africa (10%) and South Asia (14%) having the lowest proportions of countries in this category. Overall, the annual median cost of PD was US$18 959.2 (IQR US$10 891.4–US$31 013.8) with full private out-of-pocket payment in 4% of countries and the highest median cost in LICs (US$30 064.4) compared with other country income levels (e.g. HICs US$27 206.0).ConclusionsOngoing large gaps and variability in the availability, access and affordability of PD across countries and world regions were observed. Of note, there is significant inequity in access to PD by children and for people in LICs.

Staplin, Natalie

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae133pmid: 39235194

Viecelli, Andrea K; Gately, Ryan; Barday, Zunaid; Shojai, Soroush; Arruebo, Silvia; Caskey, Fergus J; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G; Bello, Aminu K; Johnson, David W

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae144pmid: 39235196

ABSTRACTBackgroundKidney transplantation (KT) is the preferred modality of kidney replacement therapy with better patient outcomes and quality of life compared with dialytic therapies. This study aims to evaluate the epidemiology, accessibility and availability of KT services in countries and regions around the world.MethodsThis study relied on data from an international survey of relevant stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology that was conducted from July to September 2022. Survey questions related to the availability, access, donor type and cost of KT.ResultsIn total, 167 countries responded to the survey. KT services were available in 70% of all countries, including 86% of high-income countries, but only 21% of low-income countries. In 80% of countries, access to KT was greater in adults than in children. The median global prevalence of KT was 279.0 [interquartile range (IQR) 58.0–492.0] per million people (pmp) and the median global incidence was 12.2 (IQR 3.0–27.8) pmp. Pre-emptive KT remained exclusive to high- and upper-middle-income countries, and living donor KT was the only available modality for KT in low-income countries. The median cost of the first year of KT was $26 903 USD and varied 1000-fold between the most and least expensive countries.ConclusionThe availability, access and affordability of KT services, especially in low-income countries, remain limited. There is an exigent need to identify strategies to ensure equitable access to KT services for people with kidney failure worldwide, especially in the low-income countries.

Yeung, Emily K; Khanal, Rohan; Sarki, Abdulshahid; Arruebo, Silvia; Damster, Sandrine; Donner, Jo-Ann; Caskey, Fergus J; Jha, Vivekanand; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Ye, Feng; Okpechi, Ikechi G; Bello, Aminu K; Tonelli, Marcello; Johnson, David W

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae128pmid: 39235195

ABSTRACTBackgroundGovernance, health financing, and service delivery are critical elements of health systems for provision of robust and sustainable chronic disease care. We leveraged the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to evaluate oversight and financing for kidney care worldwide.MethodsA survey was administered to stakeholders from countries affiliated with the ISN from July to September 2022. We evaluated funding models utilized for reimbursement of medications, services for the management of chronic kidney disease, and provision of kidney replacement therapy (KRT). We also assessed oversight structures for the delivery of kidney care.ResultsOverall, 167 of the 192 countries and territories contacted responded to the survey, representing 97.4% of the global population. High-income countries tended to use public funding to reimburse all categories of kidney care in comparison with low-income countries (LICs) and lower-middle income countries (LMICs). In countries where public funding for KRT was available, 78% provided universal health coverage. The proportion of countries that used public funding to fully reimburse care varied for non-dialysis chronic kidney disease (27%), dialysis for acute kidney injury (either hemodialysis or peritoneal dialysis) (44%), chronic hemodialysis (45%), chronic peritoneal dialysis (42%), and kidney transplant medications (36%). Oversight for kidney care was provided at a national level in 63% of countries, and at a state/provincial level in 28% of countries.ConclusionThis study demonstrated significant gaps in universal care coverage, and in oversight and financing structures for kidney care, particularly in in LICs and LMICs.

Htay, Htay; Cho, Yeoungjee; Jha, Vivekanand; See, Emily; Arruebo, Silvia; Caskey, Fergus J; Damster, Sandrine; Donner, Jo-Ann; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G; Bello, Aminu K; Johnson, David W

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae131pmid: 39235197

ABSTRACTBackgroundHemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide.MethodsThis cross-sectional study relied on desk research data as well as survey data from stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology from July to September 2022.ResultsOverall, 167 countries or jurisdictions participated in the survey. In-center HD was available in 98% of countries with a median global prevalence of 322.7 [interquartile range (IQR) 76.3–648.8] per million population (pmp), ranging from 12.2 (IQR 3.9–103.0) pmp in Africa to 1575 (IQR 282.2–2106.8) pmp in North and East Asia. Overall, home HD was available in 30% of countries, mostly in countries of Western Europe (82%). In 74% of countries, more than half of people with kidney failure were able to access HD. HD centers increased with increasing country income levels from 0.31 pmp in low-income countries to 9.31 pmp in high-income countries. Overall, the annual cost of in-center HD was US$19 380.3 (IQR 11 817.6–38 005.4), and was highest in North America and the Caribbean (US$39 825.9) and lowest in South Asia (US$4310.2). In 19% of countries, HD services could not be accessed by children.ConclusionsThis study shows significant variations that have remained consistent over the years in availability, access and affordability of HD across countries with severe limitations in lower-resourced countries.

Okpechi, Ikechi G; Tummalapalli, Sri Lekha; Chothia, Mogamat-Yazied; Sozio, Stephen M; Tungsanga, Somkanya; Caskey, Fergus J; Riaz, Parnian; Ameh, Oluwatoyin I; Arruebo, Silvia; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Bello, Aminu K; Johnson, David W

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae126pmid: 39235198

ABSTRACTBackgroundAn adequate workforce is needed to guarantee optimal kidney care. We used the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to provide an assessment of the global kidney care workforce.MethodsWe conducted a multinational cross-sectional survey to evaluate the global capacity of kidney care and assessed data on the number of adult and paediatric nephrologists, the number of trainees in nephrology and shortages of various cadres of the workforce for kidney care. Data are presented according to the ISN region and World Bank income categories.ResultsOverall, stakeholders from 167 countries responded to the survey. The median global prevalence of nephrologists was 11.75 per million population (pmp) (interquartile range [IQR] 1.78–24.76). Four regions had median nephrologist prevalences below the global median: Africa (1.12 pmp), South Asia (1.81 pmp), Oceania and Southeast Asia (3.18 pmp) and newly independent states and Russia (9.78 pmp). The overall prevalence of paediatric nephrologists was 0.69 pmp (IQR 0.03–1.78), while overall nephrology trainee prevalence was 1.15 pmp (IQR 0.18–3.81), with significant variations across both regions and World Bank income groups. More than half of the countries reported shortages of transplant surgeons (65%), nephrologists (64%), vascular access coordinators (59%), dialysis nurses (58%) and interventional radiologists (54%), with severe shortages reported in low- and lower-middle-income countries.ConclusionsThere are significant limitations in the available kidney care workforce in large parts of the world. To ensure the delivery of optimal kidney care worldwide, it is essential to develop national and international strategies and training capacity to address workforce shortages.

Hole, Barnaby; Wearne, Nicola; Arruebo, Silvia; Caskey, Fergus J; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G; Bello, Aminu K; Johnson, David W; Davison, Sara N

2024 Nephrology Dialysis Transplantation

doi: 10.1093/ndt/gfae129pmid: 39235199

ABSTRACTBackgroundConservative kidney management (CKM) describes supportive care for people living with kidney failure who choose not to receive or are unable to access kidney replacement therapy (KRT). This study captured the global availability of CKM services and funding.MethodsData came from the International Society of Nephrology Global Kidney Health survey conducted between June and September 2022. Availability of CKM, infrastructure, guidelines, medications and training were evaluated.ResultsCKM was available in some form in 61% of the 165 responding countries. CKM chosen through shared decision-making was available in 53%. Choice-restricted CKM—for those unable to access KRT—was available in 39%. Infrastructure to provide CKM chosen through shared decision-making was associated with national income level, reported as being “generally available” in most healthcare settings for 71% of high-income countries, 50% of upper-middle-income countries, 33% of lower-middle-income countries and 42% of low-income countries. For choice-restricted CKM, these figures were 29%, 50%, 67% and 58%, respectively. Essential medications for pain and palliative care were available in just over half of the countries, highly dependent upon income setting. Training for caregivers in symptom management in CKM was available in approximately a third of countries.ConclusionsMost countries report some capacity for CKM. However, there is considerable variability in terms of how CKM is defined, as well as what and how much care is provided. Poor access to CKM perpetuates unmet palliative care needs, and must be addressed, particularly in low-resource settings where death from untreated kidney failure is common.