Building blocks toward sustainable kidney care around the world: results from a multinational survey by the International Society of Nephrology

  • Adeera Levin
    Correspondence
    Correspondence: A. Levin, Department of Medicine, Division of Nephrology, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street Room 6010A, Vancouver, British Columbia, Canada, V6Z1Y8.
    Affiliations
    Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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      Kidney diseases in the form of acute kidney injury (AKI) and chronic kidney disease (CKD) are increasingly recognized as important public health issues due to their associations with a high burden of morbidity, mortality, and rising health care costs around the globe.
      • Mehta R.L.
      • Cerda J.
      • Burdmann E.A.
      • et al.
      International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology.
      • Couser W.G.
      • Remuzzi G.
      • Mendis S.
      • Tonelli M.
      The contribution of chronic kidney disease to the global burden of major noncommunicable diseases.
      Despite global efforts, the burden of AKI and CKD is on the rise. For instance, a recent Global Burden of Disease report changed CKD from 36th to 12th position in the Global Burden of Disease ranking within the last 2 decades.
      • Naghavi M.
      • Wang H.D.
      • Lozano R.
      • et al.
      Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
      • Forouzanfar M.H.
      • Alexander L.
      • Anderson H.R.
      • et al.
      Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
      • Jha V.
      • Arici M.
      • Collins A.J.
      • et al.
      Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference.
      • Stanifer J.W.
      • Muiru A.
      • Jafar T.H.
      • Patel U.D.
      Chronic kidney disease in low- and middle-income countries.
      There has been increased attention to the problems of both AKI and CKD judging from an increasing number of scientific papers in non-nephrology journals and strategic initiatives alerting the medical community to the importance of both conditions.
      • Naghavi M.
      • Wang H.D.
      • Lozano R.
      • et al.
      Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
      • Forouzanfar M.H.
      • Alexander L.
      • Anderson H.R.
      • et al.
      Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
      • Jha V.
      • Arici M.
      • Collins A.J.
      • et al.
      Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference.
      • Stanifer J.W.
      • Muiru A.
      • Jafar T.H.
      • Patel U.D.
      Chronic kidney disease in low- and middle-income countries.
      It is well-established that the presence of reduced kidney function is a risk amplifier for cardiovascular diseases and other chronic conditions including cancer.
      • Eckardt K.U.
      • Coresh J.
      • Devuyst O.
      • et al.
      Evolving importance of kidney disease: from subspecialty to global health burden.
      • Bello A.K.
      • Levin A.
      • Manns B.J.
      • et al.
      Effective CKD care in European Countries: challenges and opportunities for health policy.
      • Levey A.S.
      • Schoolwerth A.C.
      • Burrows N.R.
      • Williams D.E.
      • Stith K.R.
      • McClellan W.
      Comprehensive public health strategies for preventing the development, progression, and complications of CKD: report of an expert panel convened by the Centers for Disease Control and Prevention.
      Despite this, the current status of kidney care capacity, policy, and research around the globe is not well characterized.
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      Linked Article

      • Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology
        Kidney International SupplementsVol. 8Issue 2
        • Preview
          Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, n = 31), with the lowest figures obtained from Africa (7%, n = 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials.
        • Full-Text
        • PDF
      • Global overview of health systems oversight and financing for kidney care
        Kidney International SupplementsVol. 8Issue 2
        • Preview
          Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world.
        • Full-Text
        • PDF
      • Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project
        Kidney International SupplementsVol. 8Issue 2
        • Preview
          Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world’s population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings.
        • Full-Text
        • PDF
      • Guidelines, policies, and barriers to kidney care: findings from a global survey
        Kidney International SupplementsVol. 8Issue 2
        • Preview
          An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI.
        • Full-Text
        • PDF
      • Global coverage of health information systems for kidney disease: availability, challenges, and opportunities for development
        Kidney International SupplementsVol. 8Issue 2
        • Preview
          Development and planning of health care services requires robust health information systems to define the burden of disease, inform policy development, and identify opportunities to improve service provision. The global coverage of kidney disease health information systems has not been well reported, despite their potential to enhance care. As part of the Global Kidney Health Atlas, a cross-sectional survey conducted by the International Society of Nephrology, data were collected from 117 United Nations member states on the coverage and scope of kidney disease health information systems and surveillance practices.
        • Full-Text
        • PDF
      • Global nephrology workforce: gaps and opportunities toward a sustainable kidney care system
        Kidney International SupplementsVol. 8Issue 2
        • Preview
          The health workforce is the cornerstone of any health care system. An adequately trained and sufficiently staffed workforce is essential to reach universal health coverage. In particular, a nephrology workforce is critical to meet the growing worldwide burden of kidney disease. Despite some attempts, the global nephrology workforce and training capacity remains widely unknown. This multinational cross-sectional survey was part of the Global Kidney Health Atlas project, a new initiative administered by the International Society of Nephrology (ISN).
        • Full-Text
        • PDF