Capacity for the management of kidney failure in the International Society of Nephrology Oceania and South East Asia (OSEA) region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

The International Society of Nephrology (ISN) region of Oceania and South East Asia (OSEA) is a mix of high and low-income countries, with diversity in population demographics and densities. There have been three iterations of the ISN-Global Kidney Health Atlas (GKHA) which have aimed to deliver in-depth assessments of global kidney care across the spectrum from early detection of CKD to treatment of kidney failure. This paper reports the findings of the latest ISN-GKHA in relation to kidney care capacity in OSEA. Among the 30 countries/territories in OSEA, 19 (63%) participated in the ISN-GKHA, representing over 97% of the region’s population. The overall prevalence of treated kidney failure in OSEA was 1,203 per million population (pmp), 45% higher than the global median of 823 pmp. In contrast, kidney replacement therapy (KRT) in OSEA was less available than the global median (chronic hemodialysis 89% OSEA vs 98% globally, peritoneal dialysis 72% vs 79%, kidney transplantation 61% vs 70%). Only 56% of countries could provide access to dialysis to at least half of people with incident kidney failure, lower than the global median of 74% of countries with available dialysis services. There were inequalities in access to KRT across OSEA, with widespread availability and low out-of-pocket costs in high-income countries and limited availability, often coupled with large out-of-pocket costs, in middle-and low-income countries. Workforce limitations were observed across OSEA, especially in lower middle-income countries. Extensive collaborative work within OSEA and globally will help close the noted gaps in kidney care provision.