Assessment of global kidney health care status

Bello, Aminu K., Levin, Adeera, Tonelli, Marcello, Okpechi, Ikechi G., Feehally, John, Harris, David, Jindal, Kailash, Salako, Babatunde L., Rateb, Ahmed, Osman, Mohamed A., Qarni, Bilal, Saad, Syed, Lunney, Meaghan, Wiebe, Natasha and Johnson, David W. (2017) Assessment of global kidney health care status. Journal of the American Medical Association, 317 18: 1864-1881. doi:10.1001/jama.2017.4046


Author Bello, Aminu K.
Levin, Adeera
Tonelli, Marcello
Okpechi, Ikechi G.
Feehally, John
Harris, David
Jindal, Kailash
Salako, Babatunde L.
Rateb, Ahmed
Osman, Mohamed A.
Qarni, Bilal
Saad, Syed
Lunney, Meaghan
Wiebe, Natasha
Johnson, David W.
Title Assessment of global kidney health care status
Journal name Journal of the American Medical Association   Check publisher's open access policy
ISSN 0098-7484
1538-3598
Publication date 2017-05-09
Year available 2017
Sub-type Article (original research)
DOI 10.1001/jama.2017.4046
Open Access Status Not yet assessed
Volume 317
Issue 18
Start page 1864
End page 1881
Total pages 18
Place of publication Chicago, IL, United States
Publisher American Medical Association
Language eng
Abstract Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited.

To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world.

Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN.

Core areas of country capacity and response for kidney care.

Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93% (6.8 billion) of the world's population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia (OSEA) regions. Health information system (renal registry) availability was limited, particularly for acute kidney injury (8 countries [7%]) and nondialysis CKD (9 countries [8%]). International acute kidney injury and CKD guidelines were reportedly accessible in 52 (45%) and 62 (52%) countries, respectively. There was relatively low capacity for clinical studies in developing nations.

This survey demonstrated significant interregional and intraregional variability in the current capacity for kidney care across the world, including important gaps in services and workforce. Assuming the responses accurately reflect the status of kidney care in the respondent countries, the findings may be useful to inform efforts to improve the quality of kidney care worldwide.
Formatted abstract
Importance: Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited.

Objective: To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world.

Design, Settings, and Participants: Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN.

Main Outcomes and Measures: Core areas of country capacity and response for kidney care.

Results: Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93%(6.8 billion) of the world's population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia (OSEA) regions. Health information system (renal registry) availability was limited, particularly for acute kidney injury (8 countries [7%]) and nondialysis CKD (9 countries [8%]). International acute kidney injury and CKD guidelines were reportedly accessible in 52 (45%) and 62 (52%) countries, respectively. There was relatively low capacity for clinical studies in developing nations.

Conclusions and Relevance: This survey demonstrated significant interregional and intraregional variability in the current capacity for kidney care across the world, including important gaps in services and workforce. Assuming the responses accurately reflect the status of kidney care in the respondent countries, the findings may be useful to inform efforts to improve the quality of kidney care worldwide.
Keyword Urology & Nephrology
Urology & Nephrology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Clinical Medicine Publications
Admin Only - School of Clinical Medicine
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 6 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 29 May 2017, 01:00:46 EST by Web Cron on behalf of Learning and Research Services (UQ Library)