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Title: Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey.
Austin Authors: Bello, Aminu K;Levin, Adeera;Lunney, Meaghan;Osman, Mohamed A;Ye, Feng;Ashuntantang, Gloria E;Bellorin-Font, Ezequiel;Benghanem Gharbi, Mohammed;Davison, Sara N;Ghnaimat, Mohammad;Harden, Paul;Htay, Htay;Jha, Vivekanand;Kalantar-Zadeh, Kamyar;Kerr, Peter G;Klarenbach, Scott;Kovesdy, Csaba P;Luyckx, Valerie A;Neuen, Brendon L;O'Donoghue, Donal;Ossareh, Shahrzad;Perl, Jeffrey;Rashid, Harun Ur;Rondeau, Eric;See, Emily J ;Saad, Syed;Sola, Laura;Tchokhonelidze, Irma;Tesar, Vladimir;Tungsanga, Kriang;Turan Kazancioglu, Rumeyza;Wang, Angela Yee-Moon;Wiebe, Natasha;Yang, Chih-Wei;Zemchenkov, Alexander;Zhao, Ming-Hui;Jager, Kitty J;Caskey, Fergus;Perkovic, Vlado;Jindal, Kailash K;Okpechi, Ikechi G;Tonelli, Marcello;Feehally, John;Harris, David C;Johnson, David W
Affiliation: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada.
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
University of Manchester, Manchester, UK
Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
University of Leicester, Leicester, UK
Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
Sorbonne Université, Paris, France
Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada
Peking-Tsinghua Center for Life Sciences, Beijing, China
Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, MO, USA
Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Memphis VA Medical Center, Memphis, TN, USA
UCLA Fielding School of Public Health in Irvine and Los Angeles, CA, USA
Department of Internal Disease and Nephrology, North-Western State Medical University named after I I Mechnikov, Saint Petersburg, Russia
Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
College of Medicine, Chang Gung University, Taoyuan, Taiwan..
Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia
Translational Research Institute, Brisbane, QLD, Australia
Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
George Institute for Global Health, University of New South Wales Sydney, Sydney, NSW, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, University of Melbourne, Melbourne, VIC, Australia
George Institute for Global Health, Newtown, NSW, Australia
Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, VIC, Australia
Department of Medicine, Monash University, Clayton, VIC, Australia
Department of Medicine, University of Calgary, Calgary, AB, Canada
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
Population Health Sciences, University of Bristol, Bristol, UK
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
Key Lab of Renal Disease, Ministry of Health of China, Beijing, China
Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China; Beijing, China
Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Bhumirajanagarindra Kidney Institute, Bangkok, Thailand..
Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
Division of Nephrology, St Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
Salford Royal NHS Foundation Trust, Salford, UK
Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
George Institute for Global Health, UNSW, New Delhi, India
Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
University of Ottawa, Ottawa, ON, Canada
Department of Renal Medicine, Singapore General Hospital, Singapore
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon..
Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco..
Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan..
Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran..
Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh..
Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic..
Issue Date: 2019 2019
Publication information: BMJ (Clinical research ed.) 2019; 367: l5873
Abstract: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. International cross sectional survey. International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. Key stakeholders identified by ISN's national and regional leaders. Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.
DOI: 10.1136/bmj.l5873
ORCID: 0000-0002-6905-5937
PubMed URL: 31672760
Type: Journal Article
Appears in Collections:Journal articles

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