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Title: Hemodialysis Use and Practice Patterns: An International Survey Study.
Austin Authors: Htay, Htay;Bello, Aminu K;Levin, Adeera;Lunney, Meaghan;Osman, Mohamed A;Ye, Feng;Ashuntantang, Gloria E;Bellorin-Font, Ezequiel;Gharbi, Mohammed Benghanem;Davison, Sara N;Ghnaimat, Mohammad;Harden, Paul;Jha, Vivekanand;Kalantar-Zadeh, Kamyar;Kerr, Peter G;Klarenbach, Scott;Kovesdy, Csaba P;Luyckx, Valerie A;Neuen, Brendon;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;Kazancioglu, Rumeyza Turan;Yee-Moon Wang, Angela;Yang, Chih-Wei;Zemchenkov, Alexander;Zhao, Ming-Hui;Jager, Kitty J;Caskey, Fergus J;Perkovic, Vlado;Jindal, Kailash K;Okpechi, Ikechi G;Tonelli, Marcello;Harris, David C;Johnson, David W
Affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore
Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
School of Medicine, University of Melbourne, Melbourne, Australia
Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
The George Institute for Global Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
The George Institute for Global Health, Newtown, New South Wales, Australia
Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
Department of Medicine, Monash University, Clayton, Victoria, Australia
Intensive Care
Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
Translational Research Institute, Brisbane, Australia
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
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
Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
George Institute for Global Health, UNSW, New Delhi, India; Manipal Academy of Higher Education, Manipal, India; School of Public Health, Imperial College, London, UK
Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA
University of Tennessee Health Science Center, Memphis, Tennessee, USA
Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Salford Royal NHS Foundation Trust, Salford, UK; University of Manchester, Manchester, UK
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
Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France; Sorbonne Université, Paris, France
Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
Department of Medicine, Faculty of Medicine, King Chulalong Memorial Hospital, Chulalongkorn University, Bangkok, Thailand; Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
Department of Internal Disease, Clinical Pharmacology and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia; Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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; Peking-Tsinghua Center for Life Sciences (CLS), Beijing, China
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
Population Health Sciences, University of Bristol, Bristol, UK; Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
Issue Date: Mar-2021 2020-08-12
Publication information: American Journal of Kidney Diseases 2020; 77(3):326-335.e1
Abstract: Hemodialysis (HD) is the most common form of kidney replacement therapy. The study aimed to examine the use, availability, accessibility, affordability and quality of HD care worldwide. A cross-sectional survey SETTING & PARTICIPANTS: Stakeholders (clinicians, policymakers, consumer representatives) in 182 countries were convened by the International Society of Nephrology between July to September 2018. Use, availability, accessibility, affordability and quality of HD care ANALYTICAL APPROACH: Descriptive statistics RESULTS: Overall, representatives from 160 countries (88%) participated. Median country-specific use of chronic HD was 298.4 (interquartile range: 80.5-599.4) per million population (pmp). The global median HD use among new kidney failure patients was 98.0 (81.5-140.8) pmp and the median number of HD centers was 4.5 (1.2-9.9) pmp. Adequate HD services (3-4 hours, 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. Thirty-two percent of countries performed monitoring of patient-reported outcomes, 61% of small solute clearance, 60% of bone mineral markers, 51% of technique survival, and 60% of patient survival. At initiation of chronic dialysis, only 5% of countries used arteriovenous access in most patients. . Dialysis access education was suboptimal, funding for vascular access procedures was not uniform, and co-payments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs, compared with patients in only 4% high-income countries. A cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis CONCLUSIONS: In summary, findings reveal substantial variations in global HD use, availability, accessibility, quality and affordability worldwide, with the lowest use evident in low and lower-middle-income countries.
DOI: 10.1053/j.ajkd.2020.05.030
PubMed URL: 32800843
Type: Journal Article
Subjects: Accessibility to hemodialysis
Availability of hemodialysis
ESKD care
Funding for HD services
Quality of HD services
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