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

Eranga Wijewickrama, Muhammad Rafiqul Alam, Divya Bajpai, Smita Divyaveer, Fergus J Caskey, Narayan Prasad*, et al

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and healthcare personnel, using the World Health Organization’s building blocks for health systems in the ISN South Asia region. The poor status of the public healthcare system and low healthcare expenditure resulted in high out-of-pocket expenditures for people with kidney disease which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed amongst the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and the Maldives. Conservative kidney management was reported as available in 63% (n=5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality due to inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers' attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.
Original languageEnglish
Pages (from-to)123-135
Number of pages13
JournalKidney International Supplements
Volume13
Issue number1
Early online date8 Apr 2024
DOIs
Publication statusPublished - 8 Apr 2024

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Copyright 2024, International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

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