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Significant variability in capacity for kidney care across the world

Survey results representing 125 countries indicate there is significant variability in the current capacity for kidney care across the world, including important gaps in services, workforce and available technologies, such as facilities for kidney disease detection and management, according to a study. The study is being released to coincide with its presentation at the International Society of Nephrology Global Kidney Policy Forum.

Kidney disease is a substantial worldwide clinical and public health problem. Acute kidney injury (AKI) and chronic kidney disease (CKD) are linked to high health care costs, poor quality of life, and serious adverse health outcomes (including cardiovascular disease, kidney failure requiring kidney replacement therapy, infection, depression, and death). However, information about available care worldwide is limited.

Dr Aminu K Bello, of the University of Alberta, Edmonton, Canada, and colleagues analysed the results of a multinational questionnaire survey conducted from May to September 2016 by the International Society of Nephrology (ISN) in 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organisation representatives).

Responses were received from 125 of 130 countries (96%), representing an estimated 93% (6.8bn) of the world’s population. The researchers found that there was wide variation for kidney care in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance.

Overall, 95% of countries had facilities for haemodialysis, 76% for peritoneal dialysis, and 75% for kidney transplantation. In contrast, 94% of countries in Africa had facilities for haemodialysis, 45% for peritoneal dialysis, and 34% for kidney transplantation. For CKD monitoring in primary care, serum creatinine with estimated glomerular filtration rate was reported as always available in 18% of countries, and proteinuria measurements in 8% of countries.

Haemodialysis was funded publicly and free at the point of care delivery in 42% of countries; peritoneal dialysis, in 51% of countries, and transplantation services in 49% of countries. The number of nephrologists was variable and was low (less than 10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia regions.

Health information system (renal registry) availability was limited, particularly for AKI (eight countries [7%]) and non-dialysis CKD (9 countries [8%]). International AKI and CKD guidelines were reportedly accessible in 45% and 52% of countries, respectively. There was relatively low capacity for clinical studies in developing nations.

“The status of kidney health care as suggested by this study indicates that the health systems of many countries face substantial challenges in closing the large gaps that are reported to currently exist in meeting the health needs of people with AKI and CKD around the world,” the authors write. “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.”

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 ( 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.

Authors
Aminu K Bello; Adeera Levin; Marcello Tonelli; Ikechi G Okpechi; John Feehally; David Harris; Kailash Jindal; Babatunde L Salako; Ahmed Rateb; Mohamed A Osman; Bilal Qarni; Syed Saad; Meaghan Lunney; Natasha Wiebe; Feng Ye; David W Johnson

[link url="http://media.jamanetwork.com/news-item/assessment-of-global-kidney-health-care-status/"]JAMA material[/link]
[link url="http://jamanetwork.com/journals/jama/fullarticle/2623225"]JAMA abstract[/link]
[link url="http://jamanetwork.com/journals/jama/fullarticle/2623224"]JAMA editorial[/link]

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