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. , 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.

Nephrology in South Africa: Not Yet <b><i>ubuntu</i></b>

“…SA remains one of only 12 countries within Africa that perform renal transplantation and the only country in Africa that relies on deceased donation for the majority of its transplants [28]. Transplantation plays a key role in the public sector as it turns over the rationed spaces for HD.…”

Cardiovascular Disease in Dialysis Patients

“…Diabetic nephropathy remains the leading cause of ESKD globally, with the number of diabetic patients commencing dialysis increasing [3,[58][59][60]. When diabetes is the primary cause of ESKD, 5-year adjusted survival is only 38%, significantly lower than if hypertension (45%) or glomerulonephritis (55%) is the primary aetiology [61].…”

Probing renal blood volume with magnetic resonance imaging

“…Kidney diseases pose a global health burden with their steadily increasing incidence . Elucidating the efficacy of renoprotective strategies is essential en route to novel treatment options and effective prophylactic regimens for acute kidney injury (AKI) and chronic kidney diseases (CKD) .…”