Framework for establishing integrated kidney care programs in low- and middle-income countries

Nkunu, Victoria; Varghese, Cherian; Abu‐Alfa, Ali K.; Alrukhaimi, Mona; Bernieh, Bassam; Fox, Louise; Gill, John S.; Harris, David C.H.; Hou, Fan Fan; O’Connell, Philip J.; Rashid, Harun Ur; Niang, Abdou; Ossareh, Shahrzad; Tesař, Vladimı́r; Zakharova, Elena; Yang, Chih‐Wei

doi:10.1016/j.kisu.2019.11.002

Cited by 38 publications

(39 citation statements)

References 14 publications

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“…This framework prioritises preventative care due to high cost efficiency and potential for integration into other non-communicable disease prevention programme. 20 Alongside prevention, conservative care programmes are recommended. Within KRT, kidney transplantation is the most cost effective; however, this may be limited by lack of surgical expertise or lack of appropriate safeguards to facilitate organ donation and prevent organ trafficking.…”

Section: Discussionmentioning

confidence: 99%

Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey

et al. 2021

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ObjectivesThe Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide.SettingA cross-sectional global survey.ParticipantsKey stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.Primary outcomesPrimary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries.Results160 countries (covering 98% of the world’s population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries.ConclusionSignificant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.

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Section: Discussionmentioning

confidence: 99%

Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey

et al. 2021

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“…Haemodialysis is costly, and current recommendations therefore suggest that haemodialysis should be the lowest priority for LMICs seeking to establish kidney care programmes. Rather, these programmes should prioritize other approaches, including treatments to prevent or delay kidney failure, conservative care, living donor kidney transplantation and PD 11 . Nonetheless, haemodialysis is the most commonly offered form of KRT in LMICs, as well as in high-income countries (HICs) 12 , and continued increases in the uptake of haemodialysis are expected worldwide in the coming decades.…”

Section: Epidemiology Of Dialysismentioning

confidence: 99%

“…The associated increases in mortality resulting from a lack of access to KRT will create difficult choices for decision makers. Although LMIC should prioritize forms of KRT other than haemodialysis, some haemodialysis capacity will be required 11 , for example, to manage patients with hypercatabolic acute kidney injury or refractory PD-associated peritonitis, which, once available, will inevitably increase the use of this modality.…”

Section: Epidemiology Of Dialysismentioning

confidence: 99%

The current and future landscape of dialysis

Vanholder²,

et al. 2020

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The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization.

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“…Proposed activities included data capture, policy creation, definition of quality standards, evidence-based guidance, capacitybuilding, implementation, and research, as well as a performance measurement framework to assess progress. [3][4][5][6][7][8][9][10][11][12][13] In parallel, the ISN is working with the World Health Organization (WHO) to develop a technical package for those wishing to start or expand dialysis services.…”

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confidence: 99%