Considerations on equity in management of end-stage kidney disease in low- and middle-income countries

ObjectivesThe Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide.SettingA cross-sectional global survey.ParticipantsKey stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.Primary outcomesPrimary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries.Results160 countries (covering 98% of the world’s population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries.ConclusionSignificant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.

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Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference

Kidney International ◽

10.1016/j.kint.2016.09.009 ◽

2016 ◽

Vol 90 (6) ◽

pp. 1164-1174 ◽

Cited By ~ 35

Author(s):

Vivekanand Jha ◽

Mustafa Arici ◽

Allan J. Collins ◽

Guillermo Garcia-Garcia ◽

Brenda R. Hemmelgarn ◽

...

Keyword(s):

Kidney Disease ◽

Implementation Strategies ◽

Care Needs ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Perceptions of patients with end-stage kidney disease (ESKD) and their informal caregivers on palliative care as a treatment option: a qualitative study

10.21203/rs.3.rs-26605/v2 ◽

2020 ◽

Author(s):

Catherine Sarfo-Walters ◽

Edward Appiah Boateng

Keyword(s):

Palliative Care ◽

Kidney Disease ◽

Treatment Option ◽

Phenomenological Study ◽

Informal Caregivers ◽

Structured Interviews ◽

End Stage Kidney Disease ◽

Middle Income ◽

Depth Analysis ◽

End Stage

Abstract Background: Palliative care is increasingly becoming an accepted treatment choice for many individuals diagnosed with end-stage kidney disease (ESKD). Yet, its utilisation is non-existent in many lower- and middle-income countries (LMICs). This study explored the perceptions of individuals with ESKD and their informal caregivers on palliative care as a treatment option for the disease in Ghana.Methods: This was a phenomenological study, with an in-depth analysis of data collected from nine individuals with ESKD and six informal caregivers through individual, face-to-face semi-structured interviews. The study was conducted in two renal centres within the Kumasi metropolis, Ghana among individuals with ESKD seeking care from both renal centres and their informal caregivers.Results: Three main themes were derived from this study – motivation for initiating haemodialysis, facing realities of haemodialysis, and considering palliative care. Participants felt that haemodialysis (HD) was not meeting their health expectations and demonstrated a general willingness to utilise palliative care if it would reduce suffering. Conclusions: This study has shown that individuals with ESKD or their informal caregivers would consider palliative care services, if available. It paves the way for discussions about Palliative care for ESKD to begin across renal centres within Ghana and other similar settings. Exploring perspectives of clinicians in such settings could inform strategies on how to implement Palliative care for ESKD management in such settings.

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Perceptions of patients with end-stage kidney disease (ESKD) and their informal caregivers on palliative care as a treatment option: a qualitative study

10.21203/rs.3.rs-26605/v1 ◽

2020 ◽

Author(s):

Catherine Sarfo-Walters ◽

Edward Appiah Boateng

Keyword(s):

Palliative Care ◽

Kidney Disease ◽

Treatment Option ◽

Phenomenological Study ◽

Informal Caregivers ◽

Structured Interviews ◽

End Stage Kidney Disease ◽

Middle Income ◽

Depth Analysis ◽

End Stage

Abstract Background Palliative care is increasingly becoming an accepted treatment choice for many individuals diagnosed with end-stage kidney disease (ESKD). Yet, its utilisation is non-existent in many lower- and middle-income countries (LMICs). This study explored the perceptions of individuals with ESKD and their informal caregivers on palliative care as a treatment option for the disease in Ghana. Methods This was a phenomenological study, with an in-depth analysis of data collected from nine individuals with ESKD and six informal caregivers through individual, face-to-face semi-structured interviews. The study was conducted in two renal centres within the Kumasi metropolis, Ghana among individuals with ESKD seeking care from both renal centres and their informal caregivers. Results Three main themes were derived from this study – motivation for initiating haemodialysis, facing realities of haemodialysis, and considering palliative care. Participants felt that haemodialysis (HD) was not meeting their health expectations and demonstrated a general willingness to utilise palliative care if it would reduce suffering. Conclusions This study has shown that individuals with ESKD or their informal caregivers would consider palliative care services, if available. It paves the way for discussions about Palliative care for ESKD to begin across renal centres within Ghana and other similar settings. Exploring perspectives of clinicians in such settings could inform strategies on how to implement Palliative care for ESKD management in such settings.

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Perceptions of patients with end-stage kidney disease (ESKD) and their informal caregivers on palliative care as a treatment option: a qualitative study

10.21203/rs.3.rs-26605/v4 ◽

2020 ◽

Author(s):

Catherine Sarfo-Walters ◽

Edward Appiah Boateng

Keyword(s):

Palliative Care ◽

Kidney Disease ◽

Treatment Option ◽

Phenomenological Study ◽

Informal Caregivers ◽

Structured Interviews ◽

End Stage Kidney Disease ◽

Middle Income ◽

Depth Analysis ◽

End Stage

Abstract Background: Palliative care is increasingly becoming an accepted treatment choice for many individuals diagnosed with end-stage kidney disease (ESKD). Yet, its utilisation is non-existent in many lower- and middle-income countries (LMICs). This study explored the perceptions of individuals with ESKD and their informal caregivers on palliative care as a treatment option for the disease in Ghana.Methods: This was a phenomenological study, with an in-depth analysis of data collected from nine individuals with ESKD and six informal caregivers through individual, face-to-face semi-structured interviews. The study was conducted in two renal centres within the Kumasi metropolis, Ghana among individuals with ESKD seeking care from both renal centres and their informal caregivers.Results: Three main themes were derived from this study – motivation for initiating haemodialysis, facing realities of haemodialysis, and considering palliative care. Participants felt that haemodialysis (HD) was not meeting their health expectations and demonstrated a general willingness to utilise palliative care if it would reduce suffering. Conclusions: This study has shown that individuals with ESKD or their informal caregivers would consider palliative care services, if available. It paves the way for discussions about palliative care for ESKD to begin across renal centres within Ghana and other similar settings. Exploring perspectives of clinicians in such settings could inform strategies on how to implement palliative care for ESKD management in such settings.

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Chronic kidney disease in low- and middle-income countries

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv466 ◽

2016 ◽

Vol 31 (6) ◽

pp. 868-874 ◽

Cited By ~ 76

Author(s):

John W. Stanifer ◽

Anthony Muiru ◽

Tazeen H. Jafar ◽

Uptal D. Patel

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Traditional Medicines and Kidney Disease in Low- and Middle-Income Countries: Opportunities and Challenges

Seminars in Nephrology ◽

10.1016/j.semnephrol.2017.02.005 ◽

2017 ◽

Vol 37 (3) ◽

pp. 245-259 ◽

Cited By ~ 12

Author(s):

John W. Stanifer ◽

Kajiru Kilonzo ◽

Daphne Wang ◽

Guobin Su ◽

Wei Mao ◽

...

Keyword(s):

Kidney Disease ◽

Middle Income ◽

Traditional Medicines ◽

Middle Income Countries ◽

Low And Middle Income

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Chronic kidney disease in Low- and Middle- Income Countries: Protocol for a systematic review of diagnostic and prognostic models

10.1101/2021.04.24.21256041 ◽

2021 ◽

Author(s):

Edson J Ascencio ◽

Diego J Aparcana-Granda ◽

Rodrigo M Carrillo-Larco

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Data Extraction ◽

Screening Tests ◽

Prognostic Models ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

ABSTRACTBackgroundChronic Kidney Disease (CKD) is a highly prevalent condition with a large disease burden globally. In low- and middle-income countries (LMIC) the CKD screening challenges the health system. This systematic and comprehensive search of all CKD diagnostic and prognostic models in LMIC will inform screening strategies in LMIC following a risk-based approach.ObjectiveTo summarize all multivariate diagnostic and prognostic models for CKD in adults in LMIC.MethodsSystematic review. Without date or language restrictions we will search Embase, Medline, Global Health (these three through Ovid), SCOPUS and Web of Science. We seek multivariable diagnostic or prognostic models which included a random sample of the general population. We will screen titles and abstracts; we will then study the selected reports. Both phases will be done by two reviewers independently. Data extraction will be performed by two researchers independently using a pre-specified Excel form (CHARMS model). We will evaluate the risk of bias with the PROBAST tool.ConclusionThis systematic review will provide the most comprehensive list and critical appraisal of diagnostic and prognostic models for CKD available for the general population in LMIC. This evidence could inform policies and interventions to improve CKD screening in LMIC following a risk-based approach, maximizing limited resources and reaching populations with limited access to CKD screening tests. This systematic review will also reveal methodological limitations and research needs to improve CKD diagnostic and prognostic models in LMIC.

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