Global variations in funding and use of hemodialysis accesses: An international report using the ISN Global Kidney Health Atlas

Anukul Ghimire*, Samveg Shah, Utkarsh Chauhan, Kwaifa Salihu Ibrahim, Kailash K Jindal, Rumeyza Turan Kazancioglu, Valerie A. Luyckx, Jennifer M. MacRae, Fergus J Caskey, Et Al

*Corresponding author for this work

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


There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions.

Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN.

Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n=14; 64%), North & East Asia (n=4; 67%), and among high-income countries (n=24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n=7; 58%) and lowest in South Asia and Newly Independent States and Russia (n= 0 in both regions). Respondents from 50% (n=9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n=30; 75%) and Latin America (n=14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n=42; 67% for AVF/AVG, n=44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n=8; 40% for AVF/AVG, n=5; 25% for central venous catheters).

High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
Original languageEnglish
Article number159
JournalBMC Nephrology
Issue number1
Publication statusPublished - 8 May 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.


Dive into the research topics of 'Global variations in funding and use of hemodialysis accesses: An international report using the ISN Global Kidney Health Atlas'. Together they form a unique fingerprint.

Cite this