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Original Investigation
May 9, 2017

Assessment of Global Kidney Health Care Status

Author Affiliations
  • 1Department of Medicine, University of Alberta, Edmonton, Canada
  • 2Division of Nephrology, University of British Columbia, Vancouver, Canada
  • 3Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 4Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  • 5Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
  • 6University Hospitals of Leicester, University of Leicester, Leicester, England
  • 7Centre for Transplantation and Renal Research, University of Sydney at Westmead Hospital, Sydney, Australia
  • 8Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
  • 9Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
  • 10Translational Research Institute, Brisbane, Australia
  • 11Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
JAMA. 2017;317(18):1864-1881. doi:10.1001/jama.2017.4046
Key Points

Question  What is the status of kidney health care across the world?

Findings  In a survey of 125 (96%) of 130 International Society of Nephrology–affiliated countries (representing an estimated 93% of the world’s population) with a response rate of 85.8% (289 of 337 individuals surveyed), the findings identified major variation in reported service delivery, funding mechanisms for kidney replacement therapy, and available technologies, such as facilities for kidney disease detection and management (eg, serum creatinine and proteinuria assessments).

Meaning  These findings on the status of global kidney care may inform efforts by governmental and nongovernmental groups to improve the quality of kidney care worldwide.


Importance  Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited.

Objective  To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world.

Design, Setting, and Participants  Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN.

Main Outcomes and Measures  Core areas of country capacity and response for kidney care.

Results  Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93% (6.8 billion) of the world’s population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia (OSEA) regions. Health information system (renal registry) availability was limited, particularly for acute kidney injury (8 countries [7%]) and nondialysis CKD (9 countries [8%]). International acute kidney injury and CKD guidelines were reportedly accessible in 52 (45%) and 62 (52%) countries, respectively. There was relatively low capacity for clinical studies in developing nations.

Conclusions and Relevance  This survey demonstrated significant interregional and intraregional variability in the current capacity for kidney care across the world, including important gaps in services and workforce. Assuming the responses accurately reflect the status of kidney care in the respondent countries, the findings may be useful to inform efforts to improve the quality of kidney care worldwide.