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3. Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure

Author

Davison, Sara N., Pommer, Wolfgang, Brown, Mark A., Douglas, Claire A., Gelfand, Samantha L., Gueco, Irmingarda P., Hole, Barnaby D., Homma, Sumiko, Kazancıoğlu, Rümeyza T., Kitamura, Harumi, Koubar, Sahar H., Krause, Rene, Li, Kelly C., Lowney, Aoife C., Nagaraju, Shankar P., Niang, Abdou, Obrador, Gregorio T., Ohtake, Yoichi, Schell, Jane O., Scherer, Jennifer S., Smyth, Brendan, Tamba, Kaichiro, Vallath, Nandini, Wearne, Nicola, Zakharova, Elena, Zúñiga, Carlos, and Brennan, Frank P.

Published
2024
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4. Peritoneal Dialysis Use and Practice Patterns: An International Survey Study

Author

Cho, Yeoungjee, Bello, Aminu K, Levin, Adeera, Lunney, Meaghan, Osman, Mohamed A, Ye, Feng, Ashuntantang, Gloria E, Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Davison, Sara N, Ghnaimat, Mohammad, Harden, Paul, Htay, Htay, Jha, Vivekanand, Kalantar-Zadeh, Kamyar, Kerr, Peter G, Klarenbach, Scott, Kovesdy, Csaba P, Luyckx, Valerie, Neuen, Brendon, O'Donoghue, Donal, Ossareh, Shahrzad, Perl, Jeffrey, Rashid, Harun Ur, Rondeau, Eric, See, Emily J, Saad, Syed, Sola, Laura, Tchokhonelidze, Irma, Tesar, Vladimir, Tungsanga, Kriang, Kazancioglu, Rumeyza Turan, Yee-Moon Wang, Angela, Yang, Chih-Wei, Zemchenkov, Alexander, Zhao, Ming-Hui, Jager, Kitty J, Caskey, Fergus J, Jindal, Kailash K, Okpechi, Ikechi G, Tonelli, Marcello, Harris, David C, and Johnson, David W

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Kidney Disease, Aging, Health Services, Administrative Personnel, Cost Sharing, Costs and Cost Analysis, Cross-Sectional Studies, Delivery of Health Care, Developed Countries, Developing Countries, Health Expenditures, Health Policy, Health Services Accessibility, Humans, Internationality, Kidney Failure, Chronic, Nephrologists, Nephrology, Outcome Assessment, Health Care, Patient Reported Outcome Measures, Peritoneal Dialysis, Physicians, Practice Patterns, Physicians', Quality of Health Care, Surveys and Questionnaires, Epidemiology, RRT modality, access to health care, affordability of health care, end-stage renal disease, global survey, health care delivery, health care disparities, health policy, home dialysis, international differences, kidney failure, peritoneal dialysis, renal replacement therapy, Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

Rationale & objectiveApproximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.Study designA cross-sectional survey.Setting & participantsStakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.OutcomesPD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.Analytical approachDescriptive statistics.ResultsResponses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.LimitationsLow responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.ConclusionsLarge inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.

Published
2021

5. Hemodialysis Use and Practice Patterns: An International Survey Study

Author

Htay, Htay, Bello, Aminu K, Levin, Adeera, Lunney, Meaghan, Osman, Mohamed A, Ye, Feng, Ashuntantang, Gloria E, Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Davison, Sara N, Ghnaimat, Mohammad, Harden, Paul, Jha, Vivekanand, Kalantar-Zadeh, Kamyar, Kerr, Peter G, Klarenbach, Scott, Kovesdy, Csaba P, Luyckx, Valerie A, Neuen, Brendon, O'Donoghue, Donal, Ossareh, Shahrzad, Perl, Jeffrey, Rashid, Harun Ur, Rondeau, Eric, See, Emily J, Saad, Syed, Sola, Laura, Tchokhonelidze, Irma, Tesar, Vladimir, Tungsanga, Kriang, Kazancioglu, Rumeyza Turan, Yee-Moon Wang, Angela, Yang, Chih-Wei, Zemchenkov, Alexander, Zhao, Ming-Hui, Jager, Kitty J, Caskey, Fergus J, Perkovic, Vlado, Jindal, Kailash K, Okpechi, Ikechi G, Tonelli, Marcello, Harris, David C, and Johnson, David W

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Kidney Disease, Prevention, Good Health and Well Being, Arteriovenous Shunt, Surgical, Cost Sharing, Costs and Cost Analysis, Cross-Sectional Studies, Developed Countries, Developing Countries, Health Expenditures, Health Services Accessibility, Humans, Internationality, Kidney Failure, Chronic, Nephrology, Patient Reported Outcome Measures, Practice Patterns, Physicians', Quality of Health Care, Renal Dialysis, Surveys and Questionnaires, Transportation of Patients, ESKD care, HD accessibility, HD affordability, HD availability, Hemodialysis, RRT modality, end-stage kidney disease, funding for HD services, global survey, health care delivery, health care disparities, health policy, international differences, kidney failure, quality of HD services, renal replacement therapy, Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

Rationale & objectiveHemodialysis (HD) is the most common form of kidney replacement therapy. This study aimed to examine the use, availability, accessibility, affordability, and quality of HD care worldwide.Study designA cross-sectional survey.Setting & participantsStakeholders (clinicians, policy makers, and consumer representatives) in 182 countries were convened by the International Society of Nephrology from July to September 2018.OutcomesUse, availability, accessibility, affordability, and quality of HD care.Analytical approachDescriptive statistics.ResultsOverall, representatives from 160 (88%) countries participated. Median country-specific use of maintenance HD was 298.4 (IQR, 80.5-599.4) per million population (pmp). Global median HD use among incident patients with kidney failure was 98.0 (IQR, 81.5-140.8) pmp and median number of HD centers was 4.5 (IQR, 1.2-9.9) pmp. Adequate HD services (3-4 hours 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. 32% of countries performed monitoring of patient-reported outcomes; 61%, monitoring of small-solute clearance; 60%, monitoring of bone mineral markers; 51%, monitoring of technique survival; and 60%, monitoring of patient survival. At initiation of maintenance dialysis, only 5% of countries used an arteriovenous access in almost all patients. Vascular access education was suboptimal, funding for vascular access procedures was not uniform, and copayments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs compared with patients in only 4% of high-income countries.LimitationsA cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis.ConclusionsIn summary, findings reveal substantial variations in global HD use, availability, accessibility, quality, and affordability worldwide, with the lowest use evident in low- and lower-middle-income countries.

Published
2021

6. Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Bagasha, Peace, Bargman, Joanne M., Bavanandan, Sunita, Beckwith, Hannah, Bennett, Paul N., Bohm, Clara, Brennan, Frank, Burton, James O., Cavanaugh, Kerri L., Chilcot, Joseph, Choi, Peter, Cukor, Daniel, Dember, Laura M., Dong, Jie, Edwards, Dawn, Erickson, Kevin F., Figueiredo, Ana, Finkelstein, Fredric O., Fukagawa, Masafumi, Germain, Michael, Guillano, Franklin B., Hurst, Helen, Iseki, Kunitoshi, Jardine, Meg J., Jauré, Allison, Jha, Vivekanand, Jhamb, Manisha, Kanjanabuch, Talerngsak, Lerma, Edgar, Kam-Tao Li, Philip, Liew, Adrian, Małyszko, Jolanta, Proenca de Moraes, Thyago, Moranne, Olivier, Nam Ng, Marques Shek, Ostermann, Marlies, Perl, Jeffrey, Pigford, Jayne, Pommer, Wolfgang, Richardson, Michelle M., Rivara, Matthew B., Roberts, Glenda V., Sarafidis, Pantelis, Shroff, Rukshana, Slon Roblero, Maria Fernanda, Smyth, Brendan, Søndergaard, Henning, Van Der Veer, Sabine N., Vassalotti, Joseph A., Vervloet, Marc, Vincent, Lloyd, Walker, Rachael, Warren, Madeleine, Wasylynuk, Betty Ann, West, Melissa, Wilkie, Caroline, Mehrotra, Rajnish, Davison, Sara N., Farrington, Ken, Flythe, Jennifer E., Foo, Marjorie, Madero, Magdalena, Morton, Rachael L., Tsukamoto, Yusuke, Unruh, Mark L., Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C., and Brown, Edwina A.

Published
2023
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10. Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey

Author

Bello, Aminu K, Levin, Adeera, Lunney, Meaghan, Osman, Mohamed A, Ye, Feng, Ashuntantang, Gloria E, Bellorin-Font, Ezequiel, Benghanem Gharbi, Mohammed, Davison, Sara N, Ghnaimat, Mohammad, Harden, Paul, Htay, Htay, Jha, Vivekanand, Kalantar-Zadeh, Kamyar, Kerr, Peter G, Klarenbach, Scott, Kovesdy, Csaba P, Luyckx, Valerie A, Neuen, Brendon L, O'Donoghue, Donal, Ossareh, Shahrzad, Perl, Jeffrey, Rashid, Harun Ur, Rondeau, Eric, See, Emily, Saad, Syed, Sola, Laura, Tchokhonelidze, Irma, Tesar, Vladimir, Tungsanga, Kriang, Turan Kazancioglu, Rumeyza, Wang, Angela Yee-Moon, Wiebe, Natasha, Yang, Chih-Wei, Zemchenkov, Alexander, Zhao, Ming-Hui, Jager, Kitty J, Caskey, Fergus, Perkovic, Vlado, Jindal, Kailash K, Okpechi, Ikechi G, Tonelli, Marcello, Feehally, John, Harris, David C, and Johnson, David W

Subjects
Clinical Research, Health Services, Kidney Disease, Renal and urogenital, Cross-Sectional Studies, Developing Countries, Global Health, Health Services Accessibility, Humans, Kidney Failure, Chronic, Nephrology, Renal Replacement Therapy, Clinical Sciences, Public Health and Health Services, General & Internal Medicine
Abstract

ObjectiveTo determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management.DesignInternational cross sectional survey.SettingInternational Society of Nephrology (ISN) survey of 182 countries from July to September 2018.ParticipantsKey stakeholders identified by ISN's national and regional leaders.Main outcome measuresMarkers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management.ResultsResponses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (

Published
2019

11. Development of a patient-reported outcome measure for the assessment of symptom burden in pediatric chronic kidney disease (PRO-Kid)

Author

Jawa, Natasha A., Rapoport, Adam, Widger, Kimberley, Zappitelli, Michael, Davison, Sara N., Jha, Sarita, and Dart, Allison B.

Subjects
Health
Abstract

Background Chronic kidney disease (CKD) and kidney failure in childhood are associated with significant and life-altering morbidities and lower quality of life. Emerging evidence suggests that management should be guided in part by symptom burden; however, there is currently no standardized assessment tool for quantifying symptom burden in this pediatric population. This study aimed to develop and refine a patient-reported symptom assessment tool for children with CKD/kidney failure (PRO-Kid), to evaluate the frequency and impact of symptoms. Methods This was a prospective observational study of children and caregivers of children with CKD/kidney failure at two Canadian pediatric care centers. Building on previously published patient-reported outcome measures (PROs) for the assessment of symptom burden in other populations, we drafted a 13-item questionnaire. Cognitive interviews were performed with children and caregivers of children with CKD/kidney failure to iteratively refine the questionnaire. Results Twenty-four participants completed cognitive interviewing (11 children, 13 caregivers). The most common symptoms endorsed were feeling left out, feeling sad/depressed, inability to focus, tiredness, nausea, vomiting, not wanting to eat, and changes in the taste of food. Feeling left out was added to the questionnaire as almost all participants voiced this as a frequent and impactful symptom, resulting in a 14-item questionnaire. Conclusions PRO-Kid is the first pediatric CKD/kidney failure-specific PRO tool to assess symptom burden. Future work should validate this tool in a larger cohort so that it may be used to improve the care of children living with CKD/kidney failure. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Natasha A. Jawa [sup.1] , Adam Rapoport [sup.2] [sup.3] [sup.4] [sup.5] , Kimberley Widger [sup.2] [sup.6] , Michael Zappitelli [sup.1] [sup.4] [sup.7] , Sara N. Davison [sup.8] , Sarita [...]

Published
2022
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15. Global access and quality of conservative kidney management.

Author

Hole, Barnaby, Wearne, Nicola, Arruebo, Silvia, Caskey, Fergus J, Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Levin, Adeera, Nangaku, Masaomi, Saad, Syed, Tonelli, Marcello, Ye, Feng, Okpechi, Ikechi G, Bello, Aminu K, Johnson, David W, and Davison, Sara N

Subjects
RENAL replacement therapy, LOW-income countries, RESOURCE-limited settings, KIDNEY failure, HIGH-income countries
Abstract

Background Conservative kidney management (CKM) describes supportive care for people living with kidney failure who choose not to receive or are unable to access kidney replacement therapy (KRT). This study captured the global availability of CKM services and funding. Methods Data came from the International Society of Nephrology Global Kidney Health survey conducted between June and September 2022. Availability of CKM, infrastructure, guidelines, medications and training were evaluated. Results CKM was available in some form in 61% of the 165 responding countries. CKM chosen through shared decision-making was available in 53%. Choice-restricted CKM—for those unable to access KRT—was available in 39%. Infrastructure to provide CKM chosen through shared decision-making was associated with national income level, reported as being "generally available" in most healthcare settings for 71% of high-income countries, 50% of upper-middle-income countries, 33% of lower-middle-income countries and 42% of low-income countries. For choice-restricted CKM, these figures were 29%, 50%, 67% and 58%, respectively. Essential medications for pain and palliative care were available in just over half of the countries, highly dependent upon income setting. Training for caregivers in symptom management in CKM was available in approximately a third of countries. Conclusions Most countries report some capacity for CKM. However, there is considerable variability in terms of how CKM is defined, as well as what and how much care is provided. Poor access to CKM perpetuates unmet palliative care needs, and must be addressed, particularly in low-resource settings where death from untreated kidney failure is common. [ABSTRACT FROM AUTHOR]

Published
2024
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16. How to use communities of practice to support change in learning health systems: A landscape of roles and guidance for management.

Author

Brooks, Stephanie P., Ekpe Adewuyi, Esther, Wasylak, Tracy, Thomson, Denise, Davison, Sara N., and Storey, Kate

Subjects
COMMUNITIES of practice, ORGANIZATIONAL learning, COMMUNITY support, INSTRUCTIONAL systems, CATALOGS
Abstract

Background: Communities of practice support evidence‐based practice and can be, in and of themselves, applied learning spaces in organizations. However, the variety of ways that communities of practice can support learning health systems are poorly characterized. Furthermore, health system leaders have little guidance on designing and resourcing communities of practice to effectively serve learning health systems. Methods: We conducted a collective case study, examining a cross‐section of Canadian‐based communities of practice dedicated to supporting evidence‐based practice. We held semi‐structured interviews with 21 participants representing 16 communities of practice and 5 community of practice facilitation platforms that provide administration support, tools, and oversight for multiple communities of practice. Using the Conceptual Framework for Value‐Creating Learning Health Systems, we characterized the numerous roles that communities of practice can take to support learning health systems. We also pulled insights from the interviews on properly resourcing and managing communities of practice. Results: Communities of practice can advance learning health systems across learning cycles (ie, identifying learning priorities, generating data and knowledge, and implementing and evaluating change). They also act as important infrastructure required to share and coordinate across learning health systems. Community of practice facilitation platforms reduce staff members' workload, in turn, creating greater efficiency and effectiveness across community of practice lifespans. Furthermore, these platforms can be a mechanism to coordinate critical activities (e.g., priority alignment, knowledge brokerage/sharing across the broader system). Conclusion: To the authors' knowledge, this is the first study to characterize communities of practice across the learning health system landscape. With these results, learning health system leaders have a catalog that clarifies the potential communities of practice roles in knowledge generation, implementation, and uptake of new evidence. Furthermore, the results provide evidence that organizational investment in overarching community of practice facilitation platforms will strengthen and accelerate community of practice supports in learning health systems. [ABSTRACT FROM AUTHOR]

Published
2024
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26. List of Contributors

Author

Abramovitz, Blaise, primary, Adu, Dwomoa, additional, Afshinnia, Farsad, additional, Agarwal, Anupam, additional, Andrews, Sarah C., additional, Appel, Gerald, additional, Bailey, James L., additional, Bakris, George L., additional, Bauer, Carolyn A., additional, Baxi, Pravir V., additional, Berns, Jeffrey S., additional, Birks, Peter, additional, Bomback, Andrew, additional, Bose, Anirban, additional, Brosius, Frank C., additional, Brown, Lee K., additional, Bushinsky, David A., additional, Busse, Laurence W., additional, Campbell, Ruth C., additional, Canney, Mark, additional, Cathro, Helen, additional, Chávez-Iñiguez, Jonathan, additional, Chawla, Lakhmir S., additional, Chen, Sheldon, additional, Chertow, Glenn M., additional, Chew, Emily Y., additional, Chonchol, Michel, additional, Clegg, Deborah J., additional, Clive, David M., additional, Clive, Pia H., additional, Cohen, Scott D., additional, Collins, Ashte' K., additional, Cooper, James E., additional, Correa-Rotter, Ricardo, additional, Cukor, Daniel, additional, Dalal, Monica, additional, Davenport, Andrew, additional, Davis, Scott, additional, Davison, Sara N., additional, Delanaye, Pierre, additional, de Zeeuw, Dick, additional, Dobre, Mirela A., additional, Drawz, Paul, additional, Ebert, Natalie, additional, Eggers, Paul, additional, Ferrè, Silvia, additional, Freedman, Barry I., additional, Furth, Susan L., additional, Gao, Bixia, additional, García-García, Guillermo, additional, Gashti, Casey N., additional, Germino, Gregory G., additional, Goldsmith, David, additional, Golestaneh, Ladan, additional, Goligorsky, Michael S., additional, Greenberg, Arthur, additional, Gregg, L. Parker, additional, Guay-Woodford, Lisa M., additional, Hamm, Lee, additional, Hart, Allyson, additional, Haselby, Danielle, additional, Hedayati, S. Susan, additional, Heerspink, Hiddo J.L., additional, Herzog, Charles A., additional, Hostetter, Thomas H., additional, House, Andrew A., additional, Hruska, Keith A., additional, Ishani, Areef, additional, Isom, Robert T., additional, James, Matthew T., additional, Jhaveri, Kenar D., additional, Johansen, Kirsten, additional, Johnson, Richard J., additional, Kang, Duk-Hee, additional, Kanno, Hiroko, additional, Kanno, Yoshihiko, additional, Karambelkar, Amrita D., additional, Karet Frankl, Fiona E., additional, Khoury, Charbel C., additional, Kimmel, Paul L., additional, Kopp, Jeffrey B., additional, Korbet, Stephen M., additional, Kruzel-Davila, Etty, additional, Kummer, Andrew, additional, LaFave, Laura, additional, Lakkis, Jay I., additional, Lerman, Lilach O., additional, Levin, Adeera, additional, Lew, Susie Q., additional, Luyckx, Valerie A., additional, Mattoo, Tej K., additional, Maynard, Sharon E., additional, McCullough, Peter A., additional, Mehrotra, Rajnish, additional, Meyer, Timothy W., additional, Mitch, William E., additional, Moe, Orson W., additional, Mohandes, Samer, additional, Moss, Alvin H., additional, Moxey-Mims, Marva, additional, Murugapandian, Sangeetha, additional, Nath, Karl A., additional, Neugarten, Joel, additional, Neyra, Javier A., additional, Nissenson, Allen R., additional, Nobakht, Ehsan, additional, Nolin, Thomas D., additional, Norris, Keith C., additional, Norton, Jenna M., additional, Nowak, Kristen L., additional, Ojo, Akinlolu O., additional, Pahl, Madeleine V., additional, Paller, Mark S., additional, Palmer, Biff F., additional, Palmer, Nicholette D., additional, Patel, Samir S., additional, Pecoits-Filho, Roberto, additional, Peitzman, Steven J., additional, Peixoto, Aldo J., additional, Pham, Phuong-Thu T., additional, Pham, Phuong-Chi T., additional, Piraino, Beth, additional, Pisoni, Roberto, additional, Rabelink, Ton, additional, Radhakrishnan, Jai, additional, Rahman, Mahboob, additional, Raj, Dominic S., additional, Ramírez-Sandoval, Juan C., additional, Rangaswami, Janani, additional, Reckelhoff, Jane F., additional, Regunathan-Shenk, Renu, additional, Reule, Scott, additional, Ronco, Claudio, additional, Rosenberg, Mark E., additional, Rosner, Mitchell H., additional, Rovin, Brad, additional, Roy-Chaudhury, Prabir, additional, Ruebner, Rebecca, additional, Rule, Andrew D., additional, Sands, Jeff M., additional, Schlanger, Lynn E., additional, Schrauben, Sarah J., additional, Seliger, Stephen, additional, Shah, Maulin, additional, Sterns, Richard H., additional, Stites, Erik, additional, Sugatani, Toshifumi, additional, Textor, Stephen C., additional, Thadhani, Ravi, additional, Thajudeen, Bijin, additional, Thakar, Surabhi, additional, Thomas, George, additional, Townsend, Raymond R., additional, Turner, Jeffrey, additional, Unruh, Mark L., additional, Urquhart, Bradley L., additional, Vassalotti, Joseph A., additional, Vaziri, Nosratola D., additional, Velasquez, Manuel T., additional, Ver Halen, Nisha, additional, Waddy, Salina P., additional, Wang, Jinwei, additional, Weber, Marc, additional, Weir, Matthew R., additional, White, Christine A., additional, Whittier, William L., additional, Williams, Matthew J., additional, Wiseman, Alexander C., additional, Wymer, David C., additional, Wymer, David T.G., additional, Yee, Jerry, additional, Zhang, Luxia, additional, Zhuang, Shougang, additional, and Ziyadeh, Fuad N., additional

Published
2020
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28. Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Mehrotra, Rajnish, primary, Davison, Sara N., additional, Farrington, Ken, additional, Flythe, Jennifer E., additional, Foo, Marjorie, additional, Madero, Magdalena, additional, Morton, Rachael L., additional, Tsukamoto, Yusuke, additional, Unruh, Mark L., additional, Cheung, Michael, additional, Jadoul, Michel, additional, Winkelmayer, Wolfgang C., additional, Brown, Edwina A., additional, Bagasha, Peace, additional, Bargman, Joanne M., additional, Bavanandan, Sunita, additional, Beckwith, Hannah, additional, Bennett, Paul N., additional, Bohm, Clara, additional, Brennan, Frank, additional, Burton, James O., additional, Cavanaugh, Kerri L., additional, Chilcot, Joseph, additional, Choi, Peter, additional, Cukor, Daniel, additional, Dember, Laura M., additional, Dong, Jie, additional, Edwards, Dawn, additional, Erickson, Kevin F., additional, Figueiredo, Ana, additional, Finkelstein, Fredric O., additional, Fukagawa, Masafumi, additional, Germain, Michael, additional, Guillano, Franklin B., additional, Hurst, Helen, additional, Iseki, Kunitoshi, additional, Jardine, Meg J., additional, Jauré, Allison, additional, Jha, Vivekanand, additional, Jhamb, Manisha, additional, Kanjanabuch, Talerngsak, additional, Lerma, Edgar, additional, Kam-Tao Li, Philip, additional, Liew, Adrian, additional, Małyszko, Jolanta, additional, Proenca de Moraes, Thyago, additional, Moranne, Olivier, additional, Nam Ng, Marques Shek, additional, Ostermann, Marlies, additional, Perl, Jeffrey, additional, Pigford, Jayne, additional, Pommer, Wolfgang, additional, Richardson, Michelle M., additional, Rivara, Matthew B., additional, Roberts, Glenda V., additional, Sarafidis, Pantelis, additional, Shroff, Rukshana, additional, Slon Roblero, Maria Fernanda, additional, Smyth, Brendan, additional, Søndergaard, Henning, additional, Van Der Veer, Sabine N., additional, Vassalotti, Joseph A., additional, Vervloet, Marc, additional, Vincent, Lloyd, additional, Walker, Rachael, additional, Warren, Madeleine, additional, Wasylynuk, Betty Ann, additional, West, Melissa, additional, and Wilkie, Caroline, additional

Published
2023
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29. Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Wing-Shing Fung, Winston, Park, Hyeong Cheon, Hirakawa, Yosuke, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ueda, Seiji, Ye, Feng, Suzuki, Yusuke, Wang, Angela Yee-Moon, Amouzegar, Atefeh, Cai, Guangyan, Chang, Jer-Ming, Chen, Hung-Chun, Cheng, Yuk Lun, Cho, Yeoungjee, Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Divyaveer, Smita, Doi, Kent, Ekrikpo, Udeme E., Ethier, Isabelle, Fukami, Kei, Ghimire, Anukul, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Imaizumi, Takahiro, Irish, Georgina, Jindal, Kailash, Kashihara, Naoki, Kelly, Dearbhla M., Lalji, Rowena, Liu, Bi-Cheng, Maruyama, Shoichi, Nalado, Aisha M., Neuen, Brendon L., Nie, Jing, Nishiyama, Akira, Olanrewaju, Timothy O., Osman, Mohamed A., Petrova, Anna, Riaz, Parnian, Saad, Syed, Sakajiki, Aminu Muhammad, See, Emily, Sozio, Stephen M., Tang, Sydney C.W., Tiv, Sophanny, Tungsanga, Somkanya, Viecelli, Andrea, Wainstein, Marina, Yanagita, Motoko, Yang, Chih-Wei, Yang, Jihyun, Yeung, Emily K., Yu, Xueqing, Zaidi, Deenaz, Zhang, Hong, and Zhou, Lili

Abstract

Globally, there remain significant disparities in the capacity and quality of kidney care, as evidenced by the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). In the ISN North and East Asia region, the chronic kidney disease (CKD) burden varied widely; Taiwan had the heaviest burden of treated kidney failure (3679 per million population [pmp]) followed by Japan and South Korea. Except in Hong Kong, hemodialysis (HD) was the main dialysis modality for all other countries in the region and was much higher than the global median prevalence. Kidney transplantation services were generally available in the region, but the prevalence was much lower than that of dialysis. Most countries had public funding for kidney replacement therapy (KRT). The median prevalence of nephrologists was 28.7 pmp, higher than that of any other ISN region, with variation across countries. Home HD was available in only 17% of the countries, whereas conservative kidney management was available in 50%. All countries had official registries for dialysis and transplantation; however, only China and Japan had CKD registries. Advocacy groups for CKD, kidney failure, and KRT were uncommon throughout the region. Overall, all countries in the region had capacity for KRT, albeit with some shortages in their kidney care workforce. These data are useful for stakeholders to address gaps in kidney care and to reduce workforce shortages through increased use of multidisciplinary teams and telemedicine, policy changes to promote prevention and treatment of kidney failure, and increased advocacy for kidney disease in the region.

Published
2024
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30. Capacity for the management of kidney failure in the International Society of Nephrology Middle East region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Karam, Sabine, Amouzegar, Atefeh, Alshamsi, Iman Rashed, Al Ghamdi, Saeed M.G., Anwar, Siddiq, Ghnaimat, Mohammad, Saeed, Bassam, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Abu-Alfa, Ali K., Savaj, Shokoufeh, Abou-Jaoudeh, Pauline, Al Hussain, Turki, Al Salmi, Issa Salim Amur, Alrukhaimi, Mona, Alyousef, Anas, Bahous, Sola Aoun, Cai, Guangyan, Cheikh Hassan, Hicham I., Cho, Yeoungjee, Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Ethier, Isabelle, Fung, Winston Wing-Shing, Ghimire, Anukul, Hooman, Nakysa, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Jindal, Kailash, Kelly, Dearbhla M., Lalji, Rowena, Mitwali, Ahmed, Mortazavi, Mojgan, Nalado, Aisha M., Neuen, Brendon L., Olanrewaju, Timothy O., Osman, Mohamed A., Ossareh, Shahrzad, Petrova, Anna, Riaz, Parnian, Saad, Syed, Sakajiki, Aminu Muhammad, See, Emily, Sozio, Stephen M., Tiv, Sophanny, Tungsanga, Somkanya, Viecelli, Andrea, Wainstein, Marina, Wannous, Hala, Yeung, Emily K., and Zaidi, Deenaz

Abstract

The highest financial and symptom burdens and the lowest health-related quality-of-life scores are seen in people with kidney failure. A total of 11 countries in the International Society of Nephrology (ISN) Middle East region responded to the ISN-Global Kidney Health Atlas. The prevalence of chronic kidney disease (CKD) in the region ranged from 4.9% in Yemen to 12.2% in Lebanon, whereas prevalence of kidney failure treated with dialysis or transplantation ranged from 152 per million population (pmp) in the United Arab Emirates to 869 pmp in Kuwait. Overall, the incidence of kidney transplantation was highest in Saudi Arabia (20.2 pmp) and was lowest in Oman (2.2 pmp). Chronic hemodialysis (HD) and peritoneal dialysis (PD) services were available in all countries, whereas kidney transplantation was available in most countries of the region. Public government funding that makes acute dialysis, chronic HD, chronic PD, and kidney transplantation medications free at the point of delivery was available in 54.5%, 72.7%, 54.5%, and 54.5% of countries, respectively. Conservative kidney management was available in 45% of countries. Only Oman had a CKD registry; 7 countries (64%) had dialysis registries, and 8 (73%) had kidney transplantation registries. The ISN Middle East region has a high burden of kidney disease and multiple challenges to overcome. Prevention and detection of kidney disease can be improved by the design of tailored guidelines, allocation of additional resources, improvement of early detection at all levels of care, and implementation of sustainable health information systems.

Published
2024
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31. Capacity for the management of kidney failure in the International Society of Nephrology South Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Wijewickrama, Eranga, Alam, Muhammad Rafiqul, Bajpai, Divya, Divyaveer, Smita, Iyengar, Arpana, Kumar, Vivek, Qayyum, Ahad, Yadav, Shankar Prasad, Yadla, Manjusha, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Singh Shah, Dibya, Prasad, Narayan, Agarwal, Anil K., Ahmed, Ejaz, Alexander, Suceena, Amouzegar, Atefeh, Anandh, Urmila, Bansal, Shyam Bihari, Chhetri, Pramod Kumar, Cho, Yeoungjee, Choden, Ugyen, Chowdury, Nizamuddin, Conjeevaram, Arvind, Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Ekrikpo, Udeme E., Ethier, Isabelle, Mervin, Edwin Fernando, Wing-Shing Fung, Winston, George, Reena Rachel, Ghimire, Anukul, Gopal, Basu, Guditi, Swarnalatha, Herath, Chula, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Jindal, Kailash, Kaihan, Ahmad Baseer, Kar, Shubharthi, Kashem, Tasnuva, Kelly, Dearbhla M., Khanam, Asia, Kher, Vijay, Lalji, Rowena, Mahajan, Sandeep, Nalado, Aisha M., Naqvi, Rubina, Nayak, K.S., Neuen, Brendon L., Olanrewaju, Timothy O., Osman, Mohamed A., Parameswaran, Sreejith, Paudel, Klara, Petrova, Anna, Rashid, Harun Ur, Riaz, Parnian, Saad, Syed, Sahay, Manisha, Sakajiki, Aminu Muhammad, See, Emily, Shankar, Mythri, Sharma, Ajay P., Sharma, Sourabh, Shiham, Ibrahim, Singh, Geetika, Sozio, Stephen M., Tiv, Sophanny, Trivedi, Mayuri, Tungsanga, Somkanya, Viecelli, Andrea, Wainstein, Marina, Wazil, Abdul, Wijayaratne, Dilushi, Yeung, Emily K., and Zaidi, Deenaz

Abstract

The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organization’s building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers’ attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.

Published
2024
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32. Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Alparslan, Caner, Malyszko, Jolanta, Caskey, Fergus J., Aleckovic-Halilovic, Mirna, Hrušková, Zdenka, Arruebo, Silvia, Bello, Aminu K., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Tesar, Vladimir, Racki, Sanjin, Amouzegar, Atefeh, Aydin, Zehra, Barbullushi, Myftar, Bek, Sibel, Bumblyte, Inga Arune, Cho, Yeoungjee, Davids, M. Razeen, Davison, Sara N., Deltas, Constantinos, Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Ethier, Isabelle, Fogo, Agnes B., Wing-Shing Fung, Winston, Ghimire, Anukul, Honsova, Eva, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Jindal, Kailash, Kazancıoğlu, Rümeyza, Kelly, Dearbhla M., Krajewska, Magdalena, Laganovic, Mario, Lalji, Rowena, Nalado, Aisha M., Naumovic, Radomir, Neuen, Brendon L., Nikolova-Vlahova, Milena Krasimirova, Nistor, Ionut, Olanrewaju, Timothy O., Osman, Mohamed A., Ots-Rosenberg, Mai, Petrova, Anna, Podracka, Ludmila, Resic, Halima, Riaz, Parnian, Rosivall, Laszlo, Saad, Syed, Sakajiki, Aminu Muhammad, See, Emily, Sever, Mehmet Sukru, Sozio, Stephen M., Spasovski, Goce, Tiv, Sophanny, Tuglular, Serhan, Tungsanga, Somkanya, Viecelli, Andrea, Wainstein, Marina, Yeung, Emily K., and Zaidi, Deenaz

Abstract

Delivery of care for kidney failure (KF) globally has a significant disparity; even in some countries, it means end of life for the person. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) tries to address gaps in KF care and standardize global nephrology care. From the third iteration of the ISN-GKHA, we present data for countries in the ISN Eastern and Central Europe region. The median prevalences of chronic kidney disease (12.8%) and treated KF (873.5 pmp) were higher than the global rates, respectively. Hemodialysis was the most preferred modality for KF in adults, whereas kidney replacement therapy was more balanced in children. Although most of the countries in the region had lower-middle–income and upper-middle–income levels, health expenditures for kidney health care were almost generally covered publicly. Nephrologists were responsible for the medical kidney care of people with KF in all countries. There was adequate infrastructure to provide all kinds of treatment for kidney care in the region. Regional characteristics such as high levels of obesity, smoking, and Balkan nephropathy as an endemic disease coupled with a shortage of workforce and finance continued to affect kidney care in the region negatively. By making organizational and legislative arrangements, partnerships with national authorities and societies may accelerate the improvement of kidney health care in the region.

Published
2024
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33. Capacity for the management of kidney failure in the International Society of Nephrology Western Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Pippias, Maria, Alfano, Gaetano, Kelly, Dearbhla M., Soler, Maria Jose, De Chiara, Letizia, Olanrewaju, Timothy O., Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Coppo, Rosanna, Lightstone, Liz, Amouzegar, Atefeh, Anders, Hans-Joachim, Baharani, Jyoti, Banerjee, Debasish, Bikbov, Boris, Brown, Edwina A., Cho, Yeoungjee, Claes, Kathleen, Clyne, Naomi, Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Divyaveer, Smita, Dreyer, Gavin, Dudley, Jan, Ekrikpo, Udeme E., Ethier, Isabelle, Evans, Rhys D.R., Fan, Stanley L.S., Wing-Shing Fung, Winston, Gallieni, Maurizio, Ghimire, Anukul, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Jindal, Kailash, Khwaja, Arif, Lalji, Rowena, Liakopoulos, Vassilios, Luyckx, Valerie A., Macia, Manuel, Marti, Hans Peter, Messa, Piergiorgio, Müller, Thomas F., Nalado, Aisha M., Neuen, Brendon L., Nitsch, Dorothea, Nolasco, Fernando, Oberbauer, Rainer, Osman, Mohamed A., Papagianni, Aikaterini, Petrova, Anna, Piccoli, Giorgina Barbara, Plant, Liam, Remuzzi, Giuseppe, Riaz, Parnian, Roelofs, Joris J., Rudnicki, Michael, Saad, Syed, Sakajiki, Aminu Muhammad, Scheppach, Johannes B., See, Emily, Shroff, Rukshana, Solbu, Marit D., Sozio, Stephen M., Strippoli, Giovanni FM., Taal, Maarten W., Ashu, James Tataw, Tiv, Sophanny, Tungsanga, Somkanya, van der Net, Jeroen B., Vanholder, Raymond C., Viecelli, Andrea, Vinen, Katie, Vogt, Bruno, Wainstein, Marina, Weinstein, Talia, Wheeler, David C., Yeung, Emily K., and Zaidi, Deenaz

Abstract

Western Europe boasts advanced health care systems, robust kidney care guidelines, and a well-established health care workforce. Despite this, significant disparities in kidney replacement therapy incidence, prevalence, and transplant access exist. This paper presents the third International Society of Nephrology Global Kidney Health Atlas’s findings on kidney care availability, accessibility, affordability, and quality in 22 Western European countries, representing 99% of the region’s population. The known chronic kidney disease (CKD) prevalence across Western Europe averages 10.6%, slightly above the global median. Cardiovascular diseases account for a substantial portion of CKD-related deaths. Kidney failure incidence varies. Government health expenditure differs; however, most countries offer government-funded acute kidney injury, dialysis, and kidney transplantation care. Hemodialysis and peritoneal dialysis are universally available, with variations in the number of dialysis centers. Kidney transplantation is available in all countries (except for 3 microstates), with variable transplant center prevalence. Conservative kidney management (CKM) is increasingly accessible. The region’s kidney care workforce is substantial, exceeding global averages; however, workforce shortages are reported. Barriers to optimal kidney care include limited workforce capacity, lack of surveillance mechanisms, and suboptimal integration into national noncommunicable disease (NCD) strategies. Policy recognition of CKD as a health priority varies across countries. Although Western Europe exhibits strong kidney care infrastructure, opportunities for improvement exist, particularly in CKD prevention, surveillance, awareness, and policy implementation. Efforts to improve CKD care should include automated detection, educational support, and enhanced workflows. Based on these findings, health care professionals, stakeholders, and policymakers are called to act to enhance kidney care across the region.

Published
2024
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34. Capacity for the management of kidney failure in the International Society of Nephrology Newly Independent States and Russia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Prikhodina, Larisa, Komissarov, Kirill, Bulanov, Nikolay, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Gaipov, Abduzhappar, Amouzegar, Atefeh, Kyzy, Aiperi Asanbek, Cho, Yeoungjee, Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Ethier, Isabelle, Wing-Shing Fung, Winston, Ghimire, Anukul, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Ivanov, Dmytro, Jindal, Kailash, Kelly, Dearbhla M., Khamzaev, Komiljon, Lalji, Rowena, Nalado, Aisha M., Neuen, Brendon L., Olanrewaju, Timothy O., Osman, Mohamed A., Riaz, Parnian, Saad, Syed, Sakajiki, Aminu Muhammad, Sarishvili, Nora, Sarkissian, Ashot, See, Emily, Sharapov, Olimkhon N., Sozio, Stephen M., Tchokhonelidze, Irma, Tiv, Sophanny, Tungsanga, Somkanya, Viecelli, Andrea, Vishnevskii, Konstantin, Vorobyeva, Olga A., Wainstein, Marina, Yeung, Emily K., Zaidi, Deenaz, and Zakharova, Elena

Abstract

The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) was established to aid understanding of the status and capacity of countries to provide optimal kidney care worldwide. This report presents the current characteristics of kidney care in the ISN Newly Independent States (NIS) and Russia region. Although the median prevalence of chronic kidney disease (CKD) was higher (11.4%) than the global median (9.5%), the median CKD-related death rate (1.4%) and prevalence of treated kidney failure (KF) in the region (411 per million population [pmp]) were lower than they are globally (2.5% and 822.8 pmp, respectively). Capacity to provide an adequate frequency of hemodialysis (HD) and kidney transplantation services is present in all the countries (100%). In spite of significant economic advancement, the region has critical shortages of nephrologists, dietitians, transplant coordinators, social workers, palliative care physicians, and kidney supportive care nurses. Home HD remains unavailable in any country in the region. Although national registries for dialysis and kidney transplantation are available in most of the countries across the ISN NIS and Russia region, few registries exist for nondialysis CKD and acute kidney injury. Although a national strategy for improving care for CKD patients is presented in more than half of the countries, no country in the region had a CKD-specific policy. Strategies that incorporate workforce training, planning, and development for all KF caregivers could help ensure sustainable kidney care delivery in the ISN NIS and Russia region.

Published
2024
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35. Capacity for the management of kidney failure in the International Society of Nephrology Oceania and South East Asia (OSEA) region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Francis, Anna, Wainstein, Marina, Irish, Georgina, Abdul Hafidz, Muhammad Iqbal, Chen, Titi, Cho, Yeoungjee, Htay, Htay, Kanjanabuch, Talerngsak, Lalji, Rowena, Neuen, Brendon L., See, Emily, Shah, Anim, Smyth, Brendan, Tungsanga, Somkanya, Viecelli, Andrea, Yeung, Emily K., Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Wong, Muh Geot, Bavanandan, Sunita, Abdul Gafor, Abdul Halim, Amouzegar, Atefeh, Bennett, Paul, Chicano, Sonia L., Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Ethier, Isabelle, Fong, Voon Ken, Fung, Winston Wing-Shing, Ghimire, Anukul, Gopal, Basu, Phan, Hai An Ha, Harris, David C.H., Houston, Ghenette, Ibrahim, Kwaifa Salihu, Jardine, Meg J., Jindal, Kailash, Kantachuvesiri, Surasak, Kelly, Dearbhla M., Kerr, Peter, Kim, Siah, Krishnasamy, Rathika, Kwek, Jia Liang, Lee, Vincent, Liew, Adrian, Lim, Chiao Yuen, Lydia, Aida, Nalado, Aisha M., Olanrewaju, Timothy O., Osman, Mohamed A., Petrova, Anna, Pyar, Khin Phyu, Riaz, Parnian, Saad, Syed, Sakajiki, Aminu Muhammad, Sengthavisouk, Noot, Sozio, Stephen M., Srisawat, Nattachai, Tan, Eddie, Tiv, Sophanny, Tomacruz Amante, Isabelle Dominique, Villanueva, Anthony Russell, Walker, Rachael, Walker, Robert, and Zaidi, Deenaz

Abstract

The International Society of Nephrology (ISN) region of Oceania and South East Asia (OSEA) is a mix of high- and low-income countries, with diversity in population demographics and densities. Three iterations of the ISN-Global Kidney Health Atlas (GKHA) have been conducted, aiming to deliver in-depth assessments of global kidney care across the spectrum from early detection of CKD to treatment of kidney failure. This paper reports the findings of the latest ISN-GKHA in relation to kidney-care capacity in the OSEA region. Among the 30 countries and territories in OSEA, 19 (63%) participated in the ISN-GKHA, representing over 97% of the region’s population. The overall prevalence of treated kidney failure in the OSEA region was 1203 per million population (pmp), 45% higher than the global median of 823 pmp. In contrast, kidney replacement therapy (KRT) in the OSEA region was less available than the global median (chronic hemodialysis, 89% OSEA region vs. 98% globally; peritoneal dialysis, 72% vs. 79%; kidney transplantation, 61% vs. 70%). Only 56% of countries could provide access to dialysis to at least half of people with incident kidney failure, lower than the global median of 74% of countries with available dialysis services. Inequalities in access to KRT were present across the OSEA region, with widespread availability and low out-of-pocket costs in high-income countries and limited availability, often coupled with large out-of-pocket costs, in middle- and low-income countries. Workforce limitations were observed across the OSEA region, especially in lower-middle–income countries. Extensive collaborative work within the OSEA region and globally will help close the noted gaps in kidney-care provision.

Published
2024
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36. Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA)

Author

Tannor, Elliot Koranteng, Davidson, Bianca, Nlandu, Yannick, Bagasha, Peace, Bilchut, Workagegnehu Hailu, Davids, M. Razeen, Diongole, Hassane M., Ekrikpo, Udeme E., Hafiz, Ehab O.A., Ibrahim, Kwaifa Salihu, Kalyesubula, Robert, Nalado, Aisha M., Olanrewaju, Timothy O., Onu, Ugochi Chika, Pereira-Kamath, Nikhil, Sakajiki, Aminu Muhammad, Salah, Mohamed, Vincent, Lloyd, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Ashuntantang, Gloria Enow, Arogundade, Fatiu Abiola, Gawad, Mohammed Abdel, Abderrahim, Ezzedine, Akl, Ahmed, Amekoudi, Eyram Makafui Yoan, Amouzegar, Atefeh, Awobusuyi, Jacob Olugbenga, Bakoush, Omran, Chissico, Elsa R., Cho, Yeoungjee, Coker, Joshua, Cullis, Brett, Dahwa, Rumbidzai, Darwish, Rasha Ahmed, Davison, Sara N., Divyaveer, Smita, Ethier, Isabelle, Fagoonee, Kevin, Fofana, Aboubacar Sidiki, Freercks, Robert, Wing-Shing Fung, Winston, Gandzali-Ngabe, Pierre Eric, Ghimire, Anukul, Gouda, Zaghloul Elsafy, Habyarimana, Oswald, Htay, Htay, Wan, Davy Ip Min, Irish, Georgina, Ismail, Wesam, Jagne, Abubacarr, Jarraya, Faiçal, Jindal, Kailash, Kabllo, Babikir G., Kalebi, Ahmed Y., Kaze Folefack, François F., Kelly, Dearbhla M., Lalji, Rowena, Lomatayo, Ben, Mah, Sidi Mohamed, Zalba Mahamat Abderraman, Guillaume, McCulloch, Mignon, Mengistu, Yewondwossen Tadesse, Moloi, Mothusi Walter, Mwaba, Chisambo, Neuen, Brendon L., Ngigi, John, Niang, Abdou, Nyandwi, Joseph, Odeh, Emad, Osman, Mohamed A., Le Grand Ouanekpone, Cédric Patrick, Petrova, Anna, Ranivoharisoa, Eliane M., Riaz, Parnian, Saad, Syed, See, Emily, Sokwala, Ahmed, Solarin, Adaobi Uzoamaka, Sozio, Stephen M., Houssani, Tarik Sqalli, Kiswaya, Ernest Sumaili, Tia, Weu Melanie, Tiv, Sophanny, Ts'enoli, Thabang, Tungsanga, Somkanya, Ulasi, Ifeoma I., Vanglist, Ssentamu John, Viecelli, Andrea, Wadee, Shoyab, Wainstein, Marina, Wearne, Nicola, Yeung, Emily K., and Zaidi, Deenaz

Abstract

The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.

Published
2024
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37. Capacity for the management of kidney failure in the International Society of Nephrology North America and the Caribbean region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Lowe-Jones, Racquel, Ethier, Isabelle, Fisher, Lori-Ann, Wong, Michelle M.Y., Thompson, Stephanie, Nakhoul, Georges, Sandal, Shaifali, Chanchlani, Rahul, Davison, Sara N., Ghimire, Anukul, Jindal, Kailash, Osman, Mohamed A., Riaz, Parnian, Saad, Syed, Sozio, Stephen M., Tungsanga, Somkanya, Cambier, Alexandra, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Parekh, Rulan S., Anand, Shuchi, Agarwal, Anil K., Amouzegar, Atefeh, Avila-Casado, Carmen, Barton, Everard N., Behera, Suman, Felix, Melvin Bonilla, Cerda, Jorge, Cho, Yeoungjee, Cybulsky, Andrey V., Davids, M. Razeen, Diaz-González de Ferris, María Esther, Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Fogo, Agnes B., Friedman, David, Wing-Shing Fung, Winston, Furth, Susan L., Gill, John, Houston, Ghenette, Hsiao, Li-Li, Hsu, Chi-yuan, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Karam, Sabine, Kelly, Dearbhla M., Lalji, Rowena, Lerma, Edgar V., Mac-Way, Fabrice, Macedo, Etienne, Mohammed, Hassina, Nair, Devika, Nalado, Aisha M., Neuen, Brendon L., Olanrewaju, Timothy O., Vela Parada, Xavier Fernanco, Pecoits-Filho, Roberto, Petrova, Anna, Prasad, Bhanu, Radix, Lisa, Raina, Rupesh, Ullur, Avinash Rao, Rosner, Mitchell H., Sakajiki, Aminu Muhammad, See, Emily, Seshan, Surya V., Teitelbaum, Isaac, Thomas, Ian, Tiv, Sophanny, Trask, Michele, Vachharajani, Tushar J., Viecelli, Andrea, Wainstein, Marina, Walsh, Michael, Wyatt, Christina, Yeates, Karen, Yeung, Emily K., Young-Peart, Sandrica, and Zaidi, Deenaz

Abstract

The International Society of Nephrology Global Kidney Health Atlas charts the availability and capacity of kidney care globally. In the North America and the Caribbean region, the Atlas can identify opportunities for kidney care improvement, particularly in Caribbean countries where structures for systematic data collection are lacking. In this third iteration, respondents from 12 of 18 countries from the region reported a 2-fold higher than global median prevalence of dialysis and transplantation, and a 3-fold higher than global median prevalence of dialysis centers. The peritoneal dialysis prevalence was lower than the global median, and transplantation data were missing from 6 of the 10 Caribbean countries. Government-funded payments predominated for dialysis modalities, with greater heterogeneity in transplantation payor mix. Services for chronic kidney disease, such as monitoring of anemia and blood pressure, and diagnostic capability relying on serum creatinine and urinalyses were universally available. Notable exceptions in Caribbean countries included non-calcium-based phosphate binders and kidney biopsy services. Personnel shortages were reported across the region. Kidney failure was identified as a governmental priority more commonly than was chronic kidney disease or acute kidney injury. In this generally affluent region, patients have better access to kidney replacement therapy and chronic kidney disease–related services than in much of the world. Yet clear heterogeneity exists, especially among the Caribbean countries struggling with dialysis and personnel capacity. Important steps to improve kidney care in the region include increased emphasis on preventive care, a focus on home-based modalities and transplantation, and solutions to train and retain specialized allied health professionals.

Published
2024
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38. Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Author

Calice-Silva, Viviane, Neyra, Javier A., Ferreiro Fuentes, Alejandro, Singer Wallbach Massai, Krissia Kamile, Arruebo, Silvia, Bello, Aminu K., Caskey, Fergus J., Damster, Sandrine, Donner, Jo-Ann, Jha, Vivekanand, Johnson, David W., Levin, Adeera, Malik, Charu, Nangaku, Masaomi, Okpechi, Ikechi G., Tonelli, Marcello, Ye, Feng, Madero, Magdalena, Tzanno Martins, Carmen, Alvarez, Guillermo, Amouzegar, Atefeh, Arellano-Mendez, Denisse, Martinez, Gustavo Aroca, Ferrari, Roger Ayala, Bonano, Carlos, Velarde, Edwin Castillo, Chavez Iñiguez, Jonathan Samuel, Cho, Yeoungjee, Claure-Del Granado, Rolando, Correa-Rotter, Ricardo, Cueto Manzano, Alfonso M., Cusumano, Ana Maria, Davids, M. Razeen, Davison, Sara N., Diongole, Hassane M., Divyaveer, Smita, Ekrikpo, Udeme E., Ethier, Isabelle, Figueiredo, Ana Elizabeth, Wing-Shing Fung, Winston, Garcia, Guillermo Garcia, Ghimire, Anukul, Gomez, Martin, Gonzalez Bedat, Maria Carlota, Houston, Ghenette, Htay, Htay, Ibrahim, Kwaifa Salihu, Irish, Georgina, Jindal, Kailash, Kelly, Dearbhla M., Lalji, Rowena, Moura-Neto, José A., Nalado, Aisha M., Neuen, Brendon L., Noboa, Oscar, Noronha, Irene L., Olanrewaju, Timothy O., Osman, Mohamed A., Pastor Ludena, Ana Cecilia, Petrova, Anna, Pio-Abreu, Andrea, Riaz, Parnian, Rico-Fontalvo, Jorge, Rosa-Diez, Guillermo, Saad, Syed, Sakajiki, Aminu Muhammad, Santacruz, Angel Cristóbal, Santacruz, Juan, See, Emily, Soares dos Santos Junior, Augusto Cesar, Sola, Laura, Sozio, Stephen M., Tiv, Sophanny, Trimarchi, Hernan, Tungsanga, Somkanya, Viecelli, Andrea, Wainstein, Marina, Yeung, Emily K., and Zaidi, Deenaz

Abstract

Successful management of chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to high disease burden and geographic disparities and difficulties in terms of capacity, accessibility, equity, and quality of kidney failure care. Although LA has experienced significant social and economic progress over the past decades, there are still important inequities in health care access. Through this third iteration of the International Society of Nephrology Global Kidney Health Atlas, the indicators regarding kidney failure care in LA are updated. Survey responses were received from 22 of 31 (71%) countries in LA representing 96.5% of its total population. Median CKD prevalence was 10.2% (interquartile range: 8.4%–12.3%), median CKD disability-adjusted life year was 753.4 days (interquartile range: 581.3–1072.5 days), and median CKD mortality was 5.5% (interquartile range: 3.2%–6.3%). Regarding dialysis modality, hemodialysis continued to be the most used therapy, whereas peritoneal dialysis reached a plateau and kidney transplantation increased steadily over the past 10 years. In 20 (91%) countries, >50% of people with kidney failure could access dialysis, and in only 2 (9%) countries, people who had access to dialysis could initiate dialysis with peritoneal dialysis. A mix of public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) with many people incurring up to 50% of out-of-pocket costs. Few LA countries had CKD/kidney replacement therapy registries, and almost no acute kidney injury registries were reported. There was large variability in the nature and extent of kidney failure care in LA mainly related to countries’ funding structures and limited surveillance and management initiatives.

Published
2024
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44. Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Mehrotra, Rajnish, Davison, Sara N, Farrington, Ken, Flythe, Jennifer E, Foo, Marjorie, Madero, Magdalena, Morton, Rachael L, Tsukamoto, Yusuke, Unruh, Mark L, Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C, Brown, Edwina A, Conference Participants, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, and UCL - (SLuc) Service de néphrologie

Subjects
health-related quality of life, hemodialysis, peritoneal dialysis, patient-reported outcome measures, kidney failure
Abstract

Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has been related primarily to numerical targets for laboratory measures, and outcomes such as cardiovascular disease and mortality. Routine symptom assessment is not universal or standardized in dialysis care. Even when symptoms are identified, treatment options are limited and are initiated infrequently, in part because of a paucity of evidence in the dialysis population and the complexities of medication interactions in kidney failure. In May of 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference-Symptom-Based Complications in Dialysis-to identify the optimal means for diagnosing and managing symptom-based complications in patients undergoing maintenance dialysis. Participants included patients, physicians, behavioral therapists, nurses, pharmacists, and clinical researchers. They outlined foundational principles and consensus points related to identifying and addressing symptoms experienced by patients undergoing dialysis and described gaps in the knowledge base and priorities for research. Healthcare delivery and education systems have a responsibility to provide individualized symptom assessment and management. Nephrology teams should take the lead in symptom management, although this does not necessarily mean taking ownership of all aspects of care. Even when options for clinical response are limited, clinicians should focus on acknowledging, prioritizing, and managing symptoms that are most important to individual patients. A recognized factor in the initiation and implementation of improvements in symptom assessment and management is that they will be based on locally existing needs and resources.

Published
2023

45. Pain

Author

Davison, Sara N., primary and Brennan, Frank, additional

Published
2022
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47. Pruritus

Author

Teixeira, J. Pedro, primary, Combs, Sara A., additional, Germain, Michael J., additional, and Davison, Sara N., additional

Published
2022
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50. Association between Goals of Care Designation orders and health care resource use among seriously ill older adults in acute care: a multicentre prospective cohort study

Author

Earp, Madalene A., primary, Fassbender, Konrad, additional, King, Seema, additional, Douglas, Maureen, additional, Biondo, Patricia, additional, Brisebois, Amanda, additional, Davison, Sara N., additional, Sia, Winnie, additional, Wasylenko, Eric, additional, Esau, LeAnn, additional, and Simon, Jessica, additional

Published
2022
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