Dialysis outcomes across countries and regions: A Global Perspective From the International Society of Nephrology Global Kidney Health Atlas Study

Background: Kidney failure treated with hemodialysis (HD) or peritoneal dialysis (PD) is a major global health problem that is associated with increased risks of death and hospitalization. This study aimed to compare the incidence and causes of death and hospitalization during the first year of HD or PD between countries.

Methods: The third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) was conducted between June and September 2022. For this analysis, data were obtained from the cross-sectional survey of key stakeholders from ISN-affiliated countries.

Results: A total of 167 countries participated in the survey (response rate 87.4%). In 48% and 58% of countries, 1-10% of people treated with HD and PD died within the first year, respectively, with cardiovascular disease being the main cause. Access-related infections or treatment withdrawal due to cost were important causes of death in low-income countries (LICs). In most countries, <30% and <20% of HD and PD patients, respectively, required hospitalization during the first year. A greater proportion of HD and PD patients in LICs were hospitalized in the first year compared to high-income countries (HICs). Access-related infection and cardiovascular disease were the commonest causes of hospitalization among HD patients, while PD-related infection was the commonest cause in PD patients.

Conclusions: There is significant heterogeneity in the incidence and causes of death and hospitalization in patients with kidney failure treated with dialysis. These findings highlight opportunities to improve care, especially in LICs where infectious and social factors are strong contributors to adverse outcomes.