Assessment of Global Kidney Health Care Status

Abstract

Importance: Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited.

Objective: To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world.

Design, setting, and participants: Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN.

Main outcomes and measures: Core areas of country capacity and response for kidney care.

Results: Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93% (6.8 billion) of the world's population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia (OSEA) regions. Health information system (renal registry) availability was limited, particularly for acute kidney injury (8 countries [7%]) and nondialysis CKD (9 countries [8%]). International acute kidney injury and CKD guidelines were reportedly accessible in 52 (45%) and 62 (52%) countries, respectively. There was relatively low capacity for clinical studies in developing nations.

Conclusions and relevance: This survey demonstrated significant interregional and intraregional variability in the current capacity for kidney care across the world, including important gaps in services and workforce. Assuming the responses accurately reflect the status of kidney care in the respondent countries, the findings may be useful to inform efforts to improve the quality of kidney care worldwide.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Harris reports receipt of lecture fees from Roche Myanmar and Otsuka. Dr Johnson reports receipt of grants/fellowships, personal fees, and/or travel sponsorship from Baxter Healthcare, Fresenius Medical Care, Amgen, AstraZeneca, and the National Health and Medical Research Council of Australia. No other disclosures were reported.

Figures

Figure 1.. Global Prevalence of Treated End-Stage Renal Disease Per 1 Million Population

The map depicts the prevalence of treated kidney failure per 1 million population based on individual country data. Data not available indicates that data were either not known or not provided on the questionnaire for countries that received the survey.

Figure 2.. Global Distribution of Nephrologists Per 1 Million Population

The map depicts global distribution of nephrologists per 1 million population by country and region. Data not available indicates that data were either not known or not provided on the questionnaire for countries that received the survey.