An update on the global disparities in kidney disease burden and care across world countries and regions

• Published in: The Lancet global health 2024-03, Vol.12 (3), p.e382-e395
• Main Authors: Bello, Aminu K, Okpechi, Ikechi G, Levin, Adeera, Ye, Feng, Damster, Sandrine, Arruebo, Silvia, Donner, Jo-Ann, Caskey, Fergus J, Cho, Yeoungjee, Davids, M Razeen, Davison, Sara N, Htay, Htay, Jha, Vivekanand, Lalji, Rowena, Malik, Charu, Nangaku, Masaomi, See, Emily, Sozio, Stephen M, Tonelli, Marcello, Wainstein, Marina, Yeung, Emily K, Johnson, David W, Abu-Alfa, Ali K., Amouzegar, Atefeh, Anand, Shuchi, Arogundade, Fatiu Abiola, Ashuntantang, Gloria E., Bavanandan, Sunita, Coppo, Rosanna, Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Ethier, Isabelle, Fung, Winston Wing-Shing, Gaipov, Abduzhappar, Ghimire, Anukul, Houston, Ghenette, Ibrahim, Kwaifa Salihu, Irish, Georgina, Jindal, Kailash, Kelly, Dearbhla M., Lightstone, Liz, Madero, Magdalena, Nalado, Aisha M., Neuen, Brendon L., Olanrewaju, Timothy O., Osman, Mohamed A., Parekh, Rulan S., Petrova, Anna, Prasad, Narayan, Prikhodina, Larisa, Racki, Sanjin, Riaz, Parnian, Saad, Syed, Sakajiki, Aminu Muhammad, Savaj, Shokoufeh, Singh Shah, Dibya, Suzuki, Yusuke, Tesar, Vladimir, Tiv, Sophanny, Tungsanga, Somkanya, Tzanno-Martins, Carmen, Viecelli, Andrea, Wang, Angela Yee-Moon, Wong, Muh Geot, Zaidi, Deenaz
• Format: Article
• Language: English
• ISSN: 2214-109X; 2214-109X
• DOI: 10.1016/S2214-109X(23)00570-3

Since 2015, the International Society of Nephrology (ISN) Global Kidney Health Atlas (ISN-GKHA) has spearheaded multinational efforts to understand the status and capacity of countries to provide optimal kidney care, particularly in low-resource settings. In this iteration of the ISN-GKHA, we sought to extend previous findings by assessing availability, accessibility, quality, and affordability of medicines, kidney replacement therapy (KRT), and conservative kidney management (CKM). A consistent approach was used to obtain country-level data on kidney care capacity during three phases of data collection in 2016, 2018, and 2022. The current report includes a detailed literature review of published reports, databases, and registries to obtain information on the burden of chronic kidney disease and estimate the incidence and prevalence of treated kidney failure. Findings were triangulated with data from a multinational survey of opinion leaders based on the WHO's building blocks for health systems (ie, health financing, service delivery, access to essential medicines and health technology, health information systems, workforce, and governance). Country-level data were stratified by the ISN geographical regions and World Bank income groups and reported as counts and percentages, with global, regional, and income level estimates presented as medians with interquartile ranges. The literature review used information on prevalence of chronic kidney disease from 161 countries. The global median prevalence of chronic kidney disease was 9·5% (IQR 5·9–11·7) with the highest prevalence in Eastern and Central Europe (12·8%, 11·9–14·1). For the survey analysis, responses received covered 167 (87%) of 191 countries, representing 97·4% (7·700 billion of 7·903 billion) of the world population. Chronic haemodialysis was available in 162 (98%) of 165 countries, chronic peritoneal dialysis in 130 (79%), and kidney transplantation in 116 (70%). However, 121 (74%) of 164 countries were able to provide KRT to more than 50% of people with kidney failure. Children did not have access to haemodialysis in 12 (19%) of 62 countries, peritoneal dialysis in three (6%) countries, or kidney transplantation in three (6%) countries. CKM (non-dialysis management of people with kidney failure chosen through shared decision making) was available in 87 (53%) of 165 countries. The annual median costs of KRT were: US$19 380 per person for haemodialysis, $18 959 for peritoneal dialysis, and $26 903