Abstract
Rationale & Objective: Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.
Study Design: A cross-sectional survey.
Setting & Participants: Stakeholders including clinicians, policymakers, and consumer representatives in 182 countries convened by the International Society of Nephrology (ISN) between July and September 2018.
Outcomes: PD use, availability, accessibility, affordability, delivery and reporting of quality outcome measures.
Analytical Approach: Descriptive statistics Results: Responses were received from 160 (88%) countries; 313 participants (nephrologist n=257 [82%], non-nephrologist physician n=22 [7%], other health professional n=6 [2%], administrator/policy maker/civil servant n=17 [5%], other n=11 [4%]); from 156 (86%) countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 countries (19%), particularly in Africa (20/41) and other low-income (15/22) countries. In 69% of countries, PD was the initial dialysis modality for ≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1–25% of treatment costs and higher (>75%) co-payments were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges/day or equivalent on automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.
Limitations: Low responses from policymakers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.
Conclusions: Large inter- and intra-regional disparities exist in PD availability, accessibility, affordability, delivery and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.
Study Design: A cross-sectional survey.
Setting & Participants: Stakeholders including clinicians, policymakers, and consumer representatives in 182 countries convened by the International Society of Nephrology (ISN) between July and September 2018.
Outcomes: PD use, availability, accessibility, affordability, delivery and reporting of quality outcome measures.
Analytical Approach: Descriptive statistics Results: Responses were received from 160 (88%) countries; 313 participants (nephrologist n=257 [82%], non-nephrologist physician n=22 [7%], other health professional n=6 [2%], administrator/policy maker/civil servant n=17 [5%], other n=11 [4%]); from 156 (86%) countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 countries (19%), particularly in Africa (20/41) and other low-income (15/22) countries. In 69% of countries, PD was the initial dialysis modality for ≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1–25% of treatment costs and higher (>75%) co-payments were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges/day or equivalent on automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.
Limitations: Low responses from policymakers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.
Conclusions: Large inter- and intra-regional disparities exist in PD availability, accessibility, affordability, delivery and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.
| Original language | English |
|---|---|
| Pages (from-to) | 315-325 |
| Number of pages | 11 |
| Journal | American Journal of Kidney Diseases |
| Volume | 77 |
| Issue number | 3 |
| Early online date | 12 Aug 2020 |
| DOIs | |
| Publication status | Published - 1 Mar 2021 |
Bibliographical note
Funding Information:Yeoungjee Cho, MBBS, PhD, Aminu K. Bello, MBBS, PhD, Adeera Levin, MD, Meaghan Lunney, MSc, PhD, Mohamed A. Osman, MD, Feng Ye, MSc, Gloria E. Ashuntantang, MD, Ezequiel Bellorin-Font, MD, Mohammed Benghanem Gharbi, MD, Sara N. Davison, MD, MSc, Mohammad Ghnaimat, MD, Paul Harden, MD, Htay Htay, MBBS, Vivekanand Jha, MD, Kamyar Kalantar-Zadeh, MD, Peter G. Kerr, MBBS, PhD, Scott Klarenbach, MD, MSc, Csaba P. Kovesdy, MD, Valerie Luyckx, MBBCh, PhD, Brendon Neuen, MBBS, MSc, Donal O'Donoghue, MD, Shahrzad Ossareh, MD, Jeffrey Perl, MD, Harun Ur Rashid, MBBS, PhD, Eric Rondeau, MD, PhD, Emily J. See, MBBS, Syed Saad, BSc, Laura Sola, MD, Irma Tchokhonelidze, MD, Vladimir Tesar, MD, PhD, Kriang Tungsanga, MD, Rumeyza Turan Kazancioglu, MD, Angela Yee-Moon Wang, MD, PhD, Chih-Wei Yang, MD, Alexander Zemchenkov, MD, PhD, Ming-hui Zhao, MD, PhD, Kitty J. Jager, MD, PhD, Fergus J. Caskey, MD, Kailash K. Jindal, MBBS, Ikechi G. Okpechi, MBBS, PhD, Marcello Tonelli, MD, David C. Harris, MD, and David W. Johnson, MBBS, PhD. Research idea and study design: YC, AKB, AL, MAO, FY, DWJ; data acquisition: AKB, ML, MAO, FY, GEA, MBG, PH, HH, VJ, KKZ, PGK, SK, CPK, VL, BN, DO, SO, JP, HUR, ER, ES, SS, LS, IT, VT, KT, RTK, AY-MW, C-WY, AZ, M-hZ, KJJ, FC, KKJ, IGO, MT, DCH, DWJ; data analysis/interpretation: AKB, MAO, FY, YC, DWJ; statistical analysis: FY, MAO, YC; supervision and mentorship: AKB, AL, ML, MAO, FY, GEA, EB-F, MBG, SD, MG, PH, HH, VJ, KKZ, PGK, SK, CPK, VL, BN, DO, SO, JP, HUR, ER, ES, SS, LS, IT, VT, KT, RTK, AY-MW, C-WY, AZ, M-hZ, KJJ, FC, KKJ, IGO, MT, DCH, DWJ. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. This study received funding support from the ISN as part of the GKHA project. This work was also supported by ISN grant RES0033080 to the University of Alberta. Dr Cho is supported by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1126256). Dr Johnson is supported by the NHMRC Practitioner Fellowship. The ISN provided administrative support for the design and implementation of the study and data collection activities. The authors were responsible for data management, analysis, and interpretation, as well as manuscript preparation, review, and approval and the decision to submit the manuscript for publication. Dr Cho has received research grants from Baxter Healthcare and Fresenius Medical Care and speaker's honoraria from Baxter Healthcare. Dr Johnson received grants and personal fees from Baxter Healthcare and Fresenius Medical Care, other compensation from Amgen and Ono, personal fees from Astra Zeneca and AWAK, and grants from NHMRC of Australia during the study. Dr Tonelli received a lecture fee from B. Braun (donated to charity). Dr Jha reports grants from Baxter Healthcare and GSK and personal fees (all paid to the employer) from NephroPlus and Biocon. Dr Wang received grants from Baxter Corp and Sanofi Renal and speaker honorarium from Fresenius Kabi and Sanofi Renal. The remaining authors declare that they have no relevant financial interests. We thank Sandrine Damster, Senior Research Project Manager at the ISN, and Alberta Kidney Disease Network staff (G. Houston, S. Szigety, and S. Tiv) for helping organize and conduct the survey and providing project management support. The prominent role by Jo-Ann Donner (Awards, Endorsements, ISN-ANIO Programs Coordinator) on the manuscript management and submission process is well acknowledged. We thank the ISN staff (Charu Malik, Claire Van Der Linden, and Luisa Strani) for support and the GKHA steering committee, executive committee of the ISN, ISN regional leadership, and leaders of the ISN Affiliate Societies at the regional and country levels for help, particularly with identification of survey respondents and data acquisition, which ensured the success of this initiative. Received December 14, 2019. Evaluated by 3 external peer reviewers, with direct editorial input from a Statistics/Methods Editor and an Associate Editor, who served as Acting Editor-in-Chief. Accepted in revised form May 26, 2020. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Funding Information:
Dr Cho has received research grants from Baxter Healthcare and Fresenius Medical Care and speaker’s honoraria from Baxter Healthcare. Dr Johnson received grants and personal fees from Baxter Healthcare and Fresenius Medical Care, other compensation from Amgen and Ono, personal fees from Astra Zeneca and AWAK, and grants from NHMRC of Australia during the study. Dr Tonelli received a lecture fee from B. Braun (donated to charity). Dr Jha reports grants from Baxter Healthcare and GSK and personal fees (all paid to the employer) from NephroPlus and Biocon. Dr Wang received grants from Baxter Corp and Sanofi Renal and speaker honorarium from Fresenius Kabi and Sanofi Renal. The remaining authors declare that they have no relevant financial interests.
Funding Information:
This study received funding support from the ISN as part of the GKHA project. This work was also supported by ISN grant RES0033080 to the University of Alberta. Dr Cho is supported by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1126256). Dr Johnson is supported by the NHMRC Practitioner Fellowship. The ISN provided administrative support for the design and implementation of the study and data collection activities. The authors were responsible for data management, analysis, and interpretation, as well as manuscript preparation, review, and approval and the decision to submit the manuscript for publication.
Publisher Copyright:
© 2020
Keywords
- epidemiology
- health care delivery
- kidney failure
- health policy
- peritoneal dialysis
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