International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean

Abstract

The International Society of Nephrology established the Global Kidney Health Atlas project to define the global capacity for kidney replacement therapy and conservative kidney care, and this second iteration was to describe the availability, accessibility, quality, and affordability of kidney failure (KF) care worldwide. This report presents results for the International Society of Nephrology North America and the Caribbean region. Relative to other regions, the North America and Caribbean region had better infrastructure and funding for health care and more health care workers relative to the population. Various essential medicines were also more available and accessible. There was substantial variation in the prevalence of treated KF in the region, ranging from 137.4 per million population (pmp) in Jamaica to 2196 pmp in the United States. A mix of public and private funding systems cover costs for nondialysis chronic kidney disease care in 60% of countries and for dialysis in 70% of countries. Although the median number of nephrologists is 18.1 (interquartile range, 15.3-29.5) pmp, which is approximately twice the global median of 9.9 (interquartile range, 1.2-22.7) pmp, some countries reported shortages of other health care workers. Dialysis was available in all countries, but peritoneal dialysis was underutilized and unavailable in Barbados, Cayman Islands, and Turks and Caicos. Kidney transplantation was primarily available in Canada and the United States. Economic factors were the major barriers to optimal KF care in the Caribbean countries, and few countries in the region have chronic kidney disease-specific national health care policies. To address regional gaps in KF care delivery, efforts should be directed toward augmenting the workforce, improving the monitoring and reporting of kidney replacement therapy indicators, and implementing noncommunicable disease and chronic kidney disease-specific policies in all countries.

Global Dialysis Perspective: Jamaica

“…10 Jamaica has one of the highest proportion of out-of-pocket costs for hemodialysis in the region (ranging from 51% to 75%). 13 The cost of hemodialysis is approximately $90–$117 US dollars per session, with most persons (70%) dialyzed twice weekly. In Jamaica, with a median household income of US $443.71, the cost of hemodialysis is not sustainable for most (Table 1 ).…”

“…The median nephrologists per million population is 18.1 in North America and the Caribbean. 12 , 13 Strides have been made with the training of nephrologists locally, with the University of the West Indies, Mona, offering a fellowship program in nephrology, with having trained six nephrologists, and the International Society of Nephrology and private sponsoring opportunities enabling nephrologists in the United Kingdom and Canada. In addition, most nephrologists are based in Kingston and St Andrew, resulting in gaps in access to renal care in rural and central Jamaica.…”

“… 3 , 5 An estimated 12,000 Jamaicans have advanced CKD (CKD stage 5), 6 in which RRT is needed for survival, but a significant proportion lack access to this therapy. 13 In center, hemodialysis is the predominant form of RRT in Jamaica, and there is no formal national transplant program. In this review, we discuss the epidemiology, funding, and management of dialysis, with recommendations to improve dialysis care in Jamaica.…”

Kidney transplantation in low- and middle-income countries: the Transplant Links experience

“…Despite this clear clinical need, several studies highlight the current widespread deficit in providing paediatric KRT [10][11][12][13][14]. This is in stark contrast to most high-income countries, where the treatment of kidney failure is a streamlined process in which almost no patient dies for lack of treatment [15]. Furthermore, while supporting the development of kidney transplantation in LMICs, the non-governmental organisation (NGO) Transplant Links has encountered many complex barriers to both the initiation and achievement of sustainability of paediatric kidney transplant programmes.…”

Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians

“… 7 , 8 However, in the majority of countries, including the United States, in-center hemodialysis is the current dominant KRT. 9 , 10 In the United States, the Advancing American Kidney Health Initiative has presented an immediate opportunity to increase PD utilization. 9 , 11 However, despite the increased PD focus and initiatives to increase its use, PD still remains underutilized in the United States and elsewhere.…”