Aminu K Bello1, Adeera Levin2, Meaghan Lunney3, Mohamed A Osman4, Feng Ye5, Gloria E Ashuntantang6, Ezequiel Bellorin-Font7, Mohammed Benghanem Gharbi8, Sara N Davison5, Mohammad Ghnaimat9, Paul Harden10, Htay Htay11, Vivekanand Jha12,13,14, Kamyar Kalantar-Zadeh15,16, Peter G Kerr17,18, Scott Klarenbach5, Csaba P Kovesdy19,20, Valerie A Luyckx21,22, Brendon L Neuen23, Donal O'Donoghue24,25, Shahrzad Ossareh26, Jeffrey Perl27,28, Harun Ur Rashid29, Eric Rondeau30,31, Emily See32,33, Syed Saad5, Laura Sola34, Irma Tchokhonelidze35, Vladimir Tesar36, Kriang Tungsanga37,38, Rumeyza Turan Kazancioglu39, Angela Yee-Moon Wang40, Natasha Wiebe5, Chih-Wei Yang41,42, Alexander Zemchenkov43,44, Ming-Hui Zhao45,46,47,48, Kitty J Jager49, Fergus Caskey50,51, Vlado Perkovic52, Kailash K Jindal5, Ikechi G Okpechi53,54, Marcello Tonelli55,56, John Feehally57, David C Harris58, David W Johnson59,60,61. 1. Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada aminu1@ualberta.ca. 2. Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 3. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. 4. University of Ottawa, Ottawa, ON, Canada. 5. Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada. 6. Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon. 7. Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, MO, USA. 8. Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco. 9. Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan. 10. Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 11. Department of Renal Medicine, Singapore General Hospital, Singapore. 12. George Institute for Global Health, UNSW, New Delhi, India. 13. Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. 14. Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India. 15. Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA. 16. UCLA Fielding School of Public Health in Irvine and Los Angeles, CA, USA. 17. Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, VIC, Australia. 18. Department of Medicine, Monash University, Clayton, VIC, Australia. 19. Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 20. Memphis VA Medical Center, Memphis, TN, USA. 21. Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland. 22. Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 23. George Institute for Global Health, Newtown, NSW, Australia. 24. Salford Royal NHS Foundation Trust, Salford, UK. 25. University of Manchester, Manchester, UK. 26. Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran. 27. 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. 28. Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada. 29. Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh. 30. Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France. 31. Sorbonne Université, Paris, France. 32. Department of Intensive Care, Austin Health, Melbourne, VIC, Australia. 33. School of Medicine, University of Melbourne, Melbourne, VIC, Australia. 34. Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay. 35. Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia. 36. Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic. 37. Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand. 38. Bhumirajanagarindra Kidney Institute, Bangkok, Thailand. 39. Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey. 40. Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. 41. Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan. 42. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 43. Department of Internal Disease and Nephrology, North-Western State Medical University named after I I Mechnikov, Saint Petersburg, Russia. 44. Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia. 45. Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China. 46. Key Lab of Renal Disease, Ministry of Health of China, Beijing, China. 47. Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China; Beijing, China. 48. Peking-Tsinghua Center for Life Sciences, Beijing, China. 49. ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands. 50. Population Health Sciences, University of Bristol, Bristol, UK. 51. Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. 52. George Institute for Global Health, University of New South Wales Sydney, Sydney, NSW, Australia. 53. Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa. 54. Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa. 55. Department of Medicine, University of Calgary, Calgary, AB, Canada. 56. Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada. 57. University of Leicester, Leicester, UK. 58. Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia. 59. Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia. 60. Translational Research Institute, Brisbane, QLD, Australia. 61. Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Abstract
OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: 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. CONCLUSIONS: 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: 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. CONCLUSIONS: 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Iris Nieves-Anaya; M B Várgas; H Mayorga; O P García; E Colín-Ramírez; X Atilano-Carsi Journal: Int Urol Nephrol Date: 2021-01-04 Impact factor: 2.370
Authors: Angela Yee-Moon Wang; Ikechi G Okpechi; Feng Ye; Csaba P Kovesdy; Giuliano Brunori; Jerrilynn D Burrowes; Katrina Campbell; Sandrine Damster; Denis Fouque; Allon N Friedman; Giacomo Garibotto; Fitsum Guebre-Egziabher; David Harris; Kunitoshi Iseki; Vivekanand Jha; Kailash Jindal; Kamyar Kalantar-Zadeh; Brandon Kistler; Joel D Kopple; Martin Kuhlmann; Meaghan Lunney; Denise Mafra; Charu Malik; Linda W Moore; S Russ Price; Alison Steiber; Christoph Wanner; Pieter Ter Wee; Adeera Levin; David W Johnson; Aminu K Bello Journal: Clin J Am Soc Nephrol Date: 2022-01-03 Impact factor: 8.237
Authors: Meaghan Lunney; Aminu K Bello; Adeera Levin; Helen Tam-Tham; Chandra Thomas; Mohamed A Osman; Feng Ye; Ezequiel Bellorin-Font; Mohammed Benghanem Gharbi; Mohammad Ghnaimat; Htay Htay; Yeoungjee Cho; Vivekanand Jha; Shahrzad Ossareh; Eric Rondeau; Laura Sola; Irma Tchokhonelidze; Vladimir Tesar; Kriang Tungsanga; Rumeyza Turan Kazancioglu; Angela Yee-Moon Wang; Chih-Wei Yang; Alexander Zemchenkov; Ming-Hui Zhao; Kitty J Jager; Kailash K Jindal; Ikechi G Okpechi; Edwina A Brown; Mark Brown; Marcello Tonelli; David C Harris; David W Johnson; Fergus J Caskey; Sara N Davison Journal: Clin J Am Soc Nephrol Date: 2020-12-15 Impact factor: 8.237