Global variation in kidney care: national and regional differences in the care and management of patients with kidney failure

  • Author Footnotes
    13 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project (ISN-GKHA).
    Aminu K. Bello
    Correspondence
    Correspondence: Aminu K. Bello, Division of Nephrology and Immunology, Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, Alberta, Canada T6G 2G3.
    Footnotes
    13 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project (ISN-GKHA).
    Affiliations
    Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Ikechi G. Okpechi
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa

    Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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  • Vivekanand Jha
    Affiliations
    George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India

    School of Public Health, Imperial College, London, UK

    Manipal Academy of Higher Education, Manipal, India
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  • David C.H. Harris
    Affiliations
    Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
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  • Adeera Levin
    Affiliations
    Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Author Footnotes
    13 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project (ISN-GKHA).
    David W. Johnson
    Footnotes
    13 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project (ISN-GKHA).
    Affiliations
    Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Translation Research Institute, Brisbane, Queensland, Australia
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  • Author Footnotes
    13 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project (ISN-GKHA).
      The global health impacts of kidney disease are increasingly recognized because of the rising burden of disease and associated health consequences. According to the most recent estimates from the Global Burden of Disease study, chronic kidney disease (CKD) has become the 12th leading cause of death, up from the 17th position approximately 3 decades ago.
      • Bikbov B.
      • Purcell C.
      • Levey A.
      • et al.
      Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
      The number of patients with kidney failure receiving kidney replacement therapy (KRT; dialysis and transplantation) was estimated to be 2.62 million in 2010, and this figure is projected to double by 2030, affecting almost 5.44 million people worldwide and up to 14.5 million needing KRT by 2030.
      • Liyanage T.
      • Ninomiya T.
      • Jha V.
      • et al.
      Worldwide access to treatment for end-stage kidney disease: a systematic review.
      This growth in the number of people requiring KRT has revealed significant disparities across nation states. For instance, treatment gaps between those who receive KRT and those who need it are quite high, particularly in low-income regions such as Asia and Africa, where 1.91 million and 0.43 million people, respectively, in 2010 were not receiving necessary KRT.
      • Liyanage T.
      • Ninomiya T.
      • Jha V.
      • et al.
      Worldwide access to treatment for end-stage kidney disease: a systematic review.
      Various factors such as the public spending on health care, health system characteristics, and clinical practice culture contribute to treatment disparities. A country’s capacity to provide optimal care for patients living with kidney failure largely depends on adequate funding, a workforce with sufficient capacity to meet demand, access to essential medicines, and appropriate infrastructure for care delivery. Differences in these factors across world regions and countries have not been studied systematically.
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