Global case studies for chronic kidney disease/end-stage kidney disease care

      The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities. This collection of case studies is from 15 countries from around the world and offers valuable learning examples from a variety of contexts. The variability in approaches may be explained by country differences in burden of disease, available human or financial resources, income status, and cost structures. In addition, cultural considerations, political context, and competing interests from other stakeholders must be considered. Although the approaches taken have often varied substantially, a common theme is the potential benefits of multistakeholder engagement aimed at improving the availability and scope of integrated kidney care.

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      • Developing the ethical framework of end-stage kidney disease care: from practice to policy
        Kidney International SupplementsVol. 10Issue 1
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          Ethical issues relating to end-stage kidney disease (ESKD) care are increasingly being discussed by clinicians and ethicists but are still infrequently considered at a policy level or in the education and training of health care professionals. In most lower-income countries, access to kidney replacement therapies such as dialysis is not universal, leading to overt or implicit rationing of resources and potential exclusion from care of those who are unable to sustain out-of-pocket payments. These circumstances create significant inequities in access to ESKD care within and between countries and impose emotional and moral burdens on patients, families, and health care workers involved in decision-making and provision of care.
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      • Challenges for sustainable end-stage kidney disease care in low-middle-income countries: the problem of the workforce
        Kidney International SupplementsVol. 10Issue 1
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          Prevention and early detection of kidney diseases in adults and children should be a priority for any government health department. This is particularly pertinent in the low-middle-income countries, mostly in Asia, Africa, Latin America, and the Caribbean, where up to 7 million people die because of lack of end-stage kidney disease treatment. The nephrology workforce (nurses, technicians, and doctors) is limited in these countries and expanding the size and expertise of the workforce is essential to permit expansion of treatment for both chronic kidney disease and end-stage kidney disease.
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      • The second Global Kidney Health Summit outputs: developing a strategic plan to increase access to integrated end-stage kidney disease care worldwide
        Kidney International SupplementsVol. 10Issue 1
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          The articles in this edition of Kidney International Supplements describe the background, rationale, and action plans for developing a strategic approach to increase access to integrated end-stage kidney disease (ESKD) care worldwide over the next decade. It is estimated that the number of people dying globally with ESKD for want of kidney replacement therapy is up to 3 times the number who receive it.1 Kidney transplantation meets only a small fraction of this therapeutic need. Many patients with advanced kidney disease, whether receiving kidney replacement therapy or not, suffer considerably because they have no access to supportive care.
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