Guidelines, policies, and barriers to kidney care: findings from a global survey

      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. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.

      Keywords

      To read this article in full you will need to make a payment
      ISN Member Login
      ISN Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Uneke C.J.
        • Ezeoha A.E.
        • Ndukwe C.D.
        • et al.
        Enhancing leadership and governance competencies to strengthen health systems in Nigeria: assessment of organizational human resources development.
        Healthc Policy. 2012; 7: 73-84
        • Department for Health Policy, Development, and Services, Health Systems and Services, World Health Organization
        Towards Better Leadership and Management in Health: Report on an International Consultation on Strengthening Leadership and Management in Low-Income Countries: 29 January–1 February 2007, Accra, Ghana.
        World Health Organization, Working paper 10, WHO/HSS/healthsystems/2007.3.Geneva, Switzerland2007
        • World Health Organization
        Monitoring the Building Blocks of the Health Systems: A Handbook of Indicators and Their Measurement Strategies.
        World Health Organization, Geneva, Switzerland2010
        • The Lancet
        Universal health coverage—looking to the future.
        Lancet. 2016; 388: 2837
        • Jha V.
        • Garcia-Garcia G.
        • Iseki K.
        • et al.
        Chronic kidney disease: global dimension and perspectives.
        Lancet. 2013; 382: 260-272
        • 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.
        Lancet. 2015; 385: 2616-2643
        • Couser W.G.
        • Remuzzi G.
        • Mendis S.
        • et al.
        The contribution of chronic kidney disease to the global burden of major noncommunicable diseases.
        Kidney Int. 2011; 80: 1258-1270
        • Bello A.K.
        • Johnson D.W.
        • Feehally J.
        • et al.
        Global Kidney Health Atlas (GKHA): design and methods.
        Kidney Int Suppl. 2017; 7: 145-153
        • Bello A.K.
        • Levin A.
        • Tonelli M.
        • et al.
        Assessment of global kidney health care status.
        JAMA. 2017; 317: 1864-1881
        • Sabik L.M.
        • Lie R.K.
        Priority setting in health care: lessons from the experiences of eight countries.
        Int J Equity Health. 2008; 7: 4
        • 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.
        Kidney Int. 2016; 90: 1164-1174
        • Stanifer J.W.
        • Muiru A.
        • Jafar T.H.
        • Patel U.D.
        Chronic kidney disease in low- and middle-income countries.
        Nephrol Dial Transplant. 2016; 31: 868-874
        • Ponce D.
        • Balbi A.
        Acute kidney injury: risk factors and management challenges in developing countries.
        Int J Nephrol Renovasc Dis. 2016; 9: 193-200
        • Feehally J.
        The ISN 0by25 Global Snapshot Study.
        Ann Nutr Metab. 2016; 68: 29-31
      1. World Health Organization. Noncommunicable Diseases: Fact Sheet 2015. Available at: http://www.who.int/mediacentre/factsheets/fs355/en/. Accessed February 13, 2017.

        • Trieu K.
        • Neal B.
        • Hawkes C.
        • et al.
        Salt reduction initiatives around the world—a systematic review of progress towards the global target.
        PLoS One. 2015; 10: e0130247
        • Coresh J.
        A decade after the KDOQI CKD guidelines: impact on research.
        Am J Kidney Dis. 2012; 60: 701-704
        • Bou-Karroum L.
        • El-Jardali F.
        • Hemadi N.
        • et al.
        Using media to impact health policy-making: an integrative systematic review.
        Implement Sci. 2017; 12: 52
        • Haley W.E.
        • Beckrich A.L.
        • Sayre J.
        • et al.
        Improving care coordination between nephrology and primary care: a quality improvement initiative using the renal physicians association toolkit.
        Am J Kidney Dis. 2015; 65: 67-79
        • Li P.K.
        • Burdmann E.A.
        • Mehta R.L.
        Acute kidney injury: global health alert.
        Kidney Int. 2013; 83: 372-376
        • Garcia-Garcia G.
        • Jha V.
        Chronic kidney disease in disadvantaged populations.
        Ind J Nephrol. 2015; 25: 65-69
        • Perico N.
        • Remuzzi G.
        Need for chronic kidney disease prevention programs in disadvantaged populations.
        Clin Nephrol. 2015; 83: 42-48
        • van der Veer S.N.
        • Tomson C.R.
        • Jager K.J.
        • et al.
        Bridging the gap between what is known and what we do in renal medicine: improving implementability of the European Renal Best Practice guidelines.
        Nephrol Dial Transplant. 2014; 29: 951-957
        • Tsang J.Y.
        • Blakeman T.
        • Hegarty J.
        • et al.
        Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review.
        Implement Sci. 2016; 11: 47
        • Campbell D.J.
        • Manns B.J.
        • Weaver R.G.
        • et al.
        Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study.
        BMC Med. 2017; 15: 33
        • Nam S.
        • Chesla C.
        • Stotts N.A.
        • et al.
        Barriers to diabetes management: patient and provider factors.
        Diabetes Res Clin Pract. 2011; 93: 1-9
        • Lo C.
        • Teede H.
        • Fulcher G.
        • et al.
        Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study.
        BMC Nephrol. 2017; 18: 80
        • Eijkenaar F.
        • Emmert M.
        • Scheppach M.
        • et al.
        Effects of pay for performance in health care: a systematic review of systematic reviews.
        Health Policy. 2013; 110: 115-130
        • Shaw J.
        • Wong I.
        • Griffin B.
        • et al.
        Principles for health system capacity planning: insights for healthcare leaders.
        Healthc Q. 2017; 19: 17-22
        • Brundisini F.
        • Giacomini M.
        • DeJean D.
        • et al.
        Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis.
        Ont Health Technol Assess Ser. 2013; 13: 1-33
        • Lauckner H.M.
        • Hutchinson S.L.
        Peer support for people with chronic conditions in rural areas: a scoping review.
        Rural Remote Health. 2016; 16: 3601
        • Greer R.C.
        • Ameling J.M.
        • Cavanaugh K.L.
        • et al.
        Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.
        BMC Nephrol. 2015; 16: 37
        • Collister D.
        • Russell R.
        • Verdon J.
        • et al.
        Perspectives on optimizing care of patients in multidisciplinary chronic kidney disease clinics.
        Can J Kidney Health Dis. 2016; 3: 32
        • Kirigia J.M.
        • Kirigia D.G.
        The essence of governance in health development.
        Int Arch Med. 2011; 4: 11
      2. International Society of Nephrology. Regions. Available at: https://www.theisn.org/about-isn/regions. Accessed August 22, 2017.

      3. World Bank. World Bank country and lending groups—World Bank data help desk. Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519. Accessed August 22, 2017.