Abstract
OBJECTIVE
To assess changes in key measures of kidney care using International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) data reported in 2019 and 2023.
DESIGN:
International cross-sectional survey
SETTING
International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) surveys of 2019 and 2023 that included participants from countries in Africa (n=36), Eastern and Central Europe (n=16), Latin America (n=18), the Middle East (n=11), NIS and Russia (n=10), North America and the Caribbean (n=8), North and East Asia (n=6), OSEA (n=15), South Asia (n=7), and Western Europe (n=21).
PARTICIPANTS
Countries that participated in both surveys (2019 and 2023)
MAIN OUTCOME MEASURES
Comparison of 2019 and 2023 ISN-GKHA data on availability of kidney replacement therapy (KRT) services, access, health financing, workforce, registries, and policies for kidney care. Data for countries that participated in both surveys (2019 and 2023) were included in our analysis. Country data were aggregated by ISN regions and World Bank income levels. Proportionate changes in the status of these measures across both periods were reported.
RESULTS
Data for 148 countries that participated in both surveys were available for analysis. The proportions of countries that provided public funding (free at point of delivery) increased from 27% in 2019 to 28% in 2023 for hemodialysis (HD), 23% to 28% for peritoneal dialysis (PD), and 31% to 36% for kidney transplantation (KT) services. Hemodialysis, PD, and KT centers increased from 4.4 per million population [pmp] to 4.8 pmp (P<0.001), 1.4 pmp to 1.6 pmp, and 0.43 pmp to 0.46 pmp, respectively. Overall, access to HD and PD improved, however, access to KT decreased from 30 pmp to 29 pmp. The global median prevalence of nephrologists increased from 9.5 pmp to 12.4 pmp (P<0.001). Changes across regions and country income levels in the availability of kidney registries and in national policies and strategies for kidney care were variable. The reporting of specific barriers to optimal kidney care by countries increased from 55% to 59%, 58% to 68% (P=0.043), and 46% to 52% for geographical factors, availability of nephrologists, and political factors, respectively.
CONCLUSIONS:
Important changes in key areas of kidney care delivery were noted across both periods globally. These changes impacted largely the availability of, and access to KT services. There is an important need for countries and regions to enact enabling strategies for preserving access to kidney care services, particularly kidney transplantation.
To assess changes in key measures of kidney care using International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) data reported in 2019 and 2023.
DESIGN:
International cross-sectional survey
SETTING
International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) surveys of 2019 and 2023 that included participants from countries in Africa (n=36), Eastern and Central Europe (n=16), Latin America (n=18), the Middle East (n=11), NIS and Russia (n=10), North America and the Caribbean (n=8), North and East Asia (n=6), OSEA (n=15), South Asia (n=7), and Western Europe (n=21).
PARTICIPANTS
Countries that participated in both surveys (2019 and 2023)
MAIN OUTCOME MEASURES
Comparison of 2019 and 2023 ISN-GKHA data on availability of kidney replacement therapy (KRT) services, access, health financing, workforce, registries, and policies for kidney care. Data for countries that participated in both surveys (2019 and 2023) were included in our analysis. Country data were aggregated by ISN regions and World Bank income levels. Proportionate changes in the status of these measures across both periods were reported.
RESULTS
Data for 148 countries that participated in both surveys were available for analysis. The proportions of countries that provided public funding (free at point of delivery) increased from 27% in 2019 to 28% in 2023 for hemodialysis (HD), 23% to 28% for peritoneal dialysis (PD), and 31% to 36% for kidney transplantation (KT) services. Hemodialysis, PD, and KT centers increased from 4.4 per million population [pmp] to 4.8 pmp (P<0.001), 1.4 pmp to 1.6 pmp, and 0.43 pmp to 0.46 pmp, respectively. Overall, access to HD and PD improved, however, access to KT decreased from 30 pmp to 29 pmp. The global median prevalence of nephrologists increased from 9.5 pmp to 12.4 pmp (P<0.001). Changes across regions and country income levels in the availability of kidney registries and in national policies and strategies for kidney care were variable. The reporting of specific barriers to optimal kidney care by countries increased from 55% to 59%, 58% to 68% (P=0.043), and 46% to 52% for geographical factors, availability of nephrologists, and political factors, respectively.
CONCLUSIONS:
Important changes in key areas of kidney care delivery were noted across both periods globally. These changes impacted largely the availability of, and access to KT services. There is an important need for countries and regions to enact enabling strategies for preserving access to kidney care services, particularly kidney transplantation.
| Original language | English |
|---|---|
| Journal | BMJ |
| Publication status | Accepted/In press - 3 Sept 2024 |