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

To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. International cross sectional survey. International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. Key stakeholders identified by ISN's national and regional leaders. Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. Responses 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 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf, and declare: the submitted work was supported by the International Society of Nephrology as part of its global initiatives of improving kidney health as a not-for-profit professional organisation; the authors (although all members of the International Society of Nephrology) carried out the work on a voluntary basis; outside the submitted work, PH reports grants from Chiesi Pharmaceuticals; VJ reports grants from Baxter Healthcare and GlaxoSmithKline, and consultancy fees from NephroPlus, Biocon, and George Clinical; KK-Z reports personal fees from Abbott, Abbvie, Alexion, Amag Pharma, Amgen, AstraZeneca, Aveo, Baxter, Chugai, Dr Shaer, Fresenius Medical Care, Genentech, Haymarket, Hospira, Kabi, Keryx, Novartis, PCORI, Pfizer, Relypsa, Resverlogix, Sandoz, Sanofi, Vifor, ZS-Pharma, and UpToDate, free access to national data and biobank specimensfrom DaVita, and grants and personal fees from Shire and the National Institutes of Health; PGK reports conference attendance support from Amgen Australia and honorarium from Bayer Australia; CPK reports personal fees from Abbott, Abbvie, Amgen, AstraZeneca, Bayer, Dr Schar, Fresenius Medical Care, GlaxoSmithKline, Keryx, Sanofi-Aventis, and Takeda, and grants from Shire; BN reports travel expenses from Janssen; JP reports grants and personal fees from Baxter Healthcare, Fresenius Medical Care, and Davita Healthcare partner; RTK reports personal fees from Baxter; AY-MW reports grants from Sanofi and Otsuka; KJJ reports personal fees from Fresenius Medical Care; VP reports personal fees for advisory boards or scientific presentations from Janssen, Merck, Retrophin, and Servier, fees paid to his institution for advisory boards, steering committee roles, or scientific presentations from Abbvie, Astellas, AstraZeneca, Baxter, Boehringer Ingelheim, Dimerix, Durect, Gilead, Janssen, Novartis, Novo Nordisk, Pfizer, Pharmalink, Relypsa, Sanofi, and Tricida, and grants from the National Health and Medical Research Council of Australia, Janssen, and Pfizer and senior research fellowship from National Health and Medical Research Council of Australia; MT reports grants from the Canadian Institutes for Health Research during conduct of the study; DWJ reports grants and personal fees from Baxter Healthcare and Fresenius Medical Care, travel sponsorship from Amgen, personal fees from AstraZeneca, and grants from the National Health and Medical Research Council of Australia, during the conduct of the study; the remaining authors have nothing to declare.