Global structures, practices, and tools for provision of hemodialysis

Htay Htay, Yeoungjee Cho, Vivekanand Jha, Emily See, Silvia Arruebo, Fergus J Caskey, Et Al

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


Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy (KRT) worldwide. This study assesses the organizational structures, availability, accessibility, affordability, and quality of HD care worldwide.
This cross-sectional study relied on desk research data as well as survey data from stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated with the International Society of Nephrology from July to September 2022.
Overall, 167 countries or jurisdictions participated in the survey. In-center HD was available in 98% of countries with a median global prevalence of 322.7 (interquartile range [IQR]: 76.3 – 648.8) per million population (pmp), ranging from 12.2 (IQR: 3.9–103.0) pmp in Africa to 1,575 (IQR: 282.2 – 2,106.8) pmp in North and East Asia. Overall, home HD was available in 30% of countries, mostly in countries of Western Europe (82%). In 74% of countries, more than half of people with kidney failure were able to access HD. HD centers increased with increasing country income levels from 0.31 pmp in low-income countries to 9.31 pmp in high-income countries. Overall, the annual cost of in-center HD was US$19,380.3 (IQR: 11,817.6–38,005.4) and was highest in North America and the Caribbean (US$39,825.9) and lowest in South Asia (US$4,310.2). In 19% of countries, HD services could not be accessed by children.
This study shows significant variations that have remained consistent over the years in availability, access, and affordability of HD across countries with severe limitations in lower-resourced countries.
Original languageEnglish
JournalNephrology Dialysis Transplantation
Publication statusAccepted/In press - 19 Apr 2024


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