A global assessment of kidney care workforce

Background:
An adequate workforce is needed to guarantee optimal kidney care. We used the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to provide an assessment of the global kidney care workforce.

Methods:
We conducted a multinational cross-sectional survey to evaluate the global capacity of kidney care and assessed data on the numbers of adult and pediatric nephrologists, the numbers of trainees in nephrology, and shortages of various cadres of workforce for kidney care. Data are presented according to the ISN region and World Bank income categories.

Results:
Overall, stakeholders from 167 countries responded to the survey. The median global prevalence of nephrologists was 11.75 (interquartile range [IQR]: 1.78-24.76) per million population (pmp). Four regions had median nephrologist prevalences below global median: Africa (1.12 pmp), South Asia (1.81 pmp), Oceania and South East Asia (3.18 pmp), and Newly Independent States and Russia (9.78 pmp). The overall prevalence of pediatric nephrologists was 0.69 (IQR: 0.03-1.78) pmp while overall nephrology trainee prevalence was 1.15 (IQR:0.18-3.81) pmp with significant variations across both regions and World Bank income groups. More than half of countries reported shortages of transplant surgeons (65%), nephrologists (64%), vascular access coordinators (59%), dialysis nurses (58%), and interventional radiologists (54%) with severe shortages reported from low-income and lower-middle income countries.

Conclusions:
There are significant limitations in the available kidney care workforce in large parts of the world. To ensure the delivery of optimal kidney care worldwide, it is essential to develop national and international strategies and training capacity to address workforce shortages.