Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey

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

BMJ ◽

10.1136/bmj.l5873 ◽

2019 ◽

pp. l5873 ◽

Cited By ~ 22

Author(s):

Aminu K Bello ◽

Adeera Levin ◽

Meaghan Lunney ◽

Mohamed A Osman ◽

Feng Ye ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Disease ◽

Replacement Therapy ◽

Low Income ◽

Care Delivery ◽

End Stage Kidney Disease ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Kidney Replacement Therapy ◽

End Stage

Abstract Objective To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. Design International cross sectional survey. Setting International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. Participants Key stakeholders identified by ISN’s national and regional leaders. Main outcome measures Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. Results 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. Conclusions 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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Health disparities in access to kidney replacement therapy amongst children and adolescents with end-stage kidney disease in low- and lower-middle-income countries

Kidney International ◽

10.1016/j.kint.2019.11.030 ◽

2020 ◽

Vol 97 (3) ◽

pp. 463-465 ◽

Cited By ~ 2

Author(s):

Rowena Lalji ◽

Anna Francis ◽

David W. Johnson ◽

Mignon McCulloch

Keyword(s):

Health Disparities ◽

Kidney Disease ◽

Children And Adolescents ◽

Replacement Therapy ◽

End Stage Kidney Disease ◽

Middle Income ◽

Middle Income Countries ◽

Kidney Replacement Therapy ◽

End Stage

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

Kidney International Supplements ◽

10.1016/j.kisu.2019.11.004 ◽

2020 ◽

Vol 10 (1) ◽

pp. e63-e71 ◽

Cited By ~ 5

Author(s):

Wim Van Biesen ◽

Vivekanand Jha ◽

Ali K. Abu-Alfa ◽

Sharon P. Andreoli ◽

Gloria Ashuntantang ◽

...

Keyword(s):

Kidney Disease ◽

End Stage Kidney Disease ◽

Middle Income ◽

Middle Income Countries ◽

End Stage ◽

Low And Middle Income

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Challenges for sustainable end-stage kidney disease care in low-middle-income countries: the problem of the workforce

Kidney International Supplements ◽

10.1016/j.kisu.2019.11.007 ◽

2020 ◽

Vol 10 (1) ◽

pp. e49-e54 ◽

Cited By ~ 5

Author(s):

Charles R. Swanepoel ◽

Mignon I. McCulloch ◽

Georgi Abraham ◽

Jo-Ann Donner ◽

Mona N. Alrukhaimi ◽

...

Keyword(s):

Kidney Disease ◽

End Stage Kidney Disease ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

End Stage

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Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2019-034524 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034524

Author(s):

Adeyinka Emmanuel Adegbosin ◽

Bela Stantic ◽

Jing Sun

Keyword(s):

Neural Network ◽

Deep Learning ◽

Low Income ◽

Maternal Education ◽

Household Wealth ◽

Secondary Outcome ◽

Cross Sectional ◽

Middle Income ◽

Under Five ◽

Middle Income Countries

ObjectivesTo explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.DesignThis is a cross-sectional, proof-of-concept study.Settings and participantsWe analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.Primary and secondary outcome measuresThe primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child’s survival.ResultsWe found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.ConclusionOur findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.

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Reporting of inequalities in blindness in low income and middle income countries: a review of cross sectional surveys

Clinical and Experimental Ophthalmology ◽

10.1111/ceo.13001 ◽

2017 ◽

Vol 46 (1) ◽

pp. 99-100 ◽

Cited By ~ 1

Author(s):

Jacqueline Ramke ◽

Anna Palagyi ◽

Jennifer Petkovic ◽

Clare E Gilbert

Keyword(s):

Low Income ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries

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Universal health coverage for elderly people with non-communicable diseases in low-income and middle-income countries: a cross-sectional analysis

The Lancet ◽

10.1016/s0140-6736(14)61869-9 ◽

2014 ◽

Vol 384 ◽

pp. S6 ◽

Cited By ~ 3

Author(s):

Christine Goeppel ◽

Patricia Frenz ◽

Peter Tinnemann ◽

Linus Grabenhenrich

Keyword(s):

Elderly People ◽

Universal Health Coverage ◽

Low Income ◽

Health Coverage ◽

Cross Sectional ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Sectional Analysis ◽

Universal Health

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Knowledge and Perception of Chronic Kidney Disease in a Semi-urban Community in North-east Nigeria

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.96 ◽

2019 ◽

Vol 2 (1) ◽

pp. 25-31

Author(s):

A Abdu ◽

M S Umar ◽

K Y Audi

Keyword(s):

Kidney Disease ◽

Rural Areas ◽

Urban Community ◽

Great Majority ◽

Developed Countries ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

North East ◽

End Stage

Of the nine million individuals on dialysis worldwide, more than 90% are in developed countries with lower figures reported from lower to middle-income countries. This is mainly due to Unaffordability of this therapy by the great majority of people who are poor and living in rural areas. There is, therefore, the need for effective preventive measures to reduce the progression of patients to End-Stage Kidney Disease (ESKD). This can only be achieved by properly educating the people. This community-based cross-sectional study was conducted on World Kidney day 2018 at Bayara a semi-urban community near Bauchi metropolis. Interviewer-assisted questionnaires were administered to all individuals to assess the knowledge and perception of the participants. A total of 132 individuals completed the questionnaire out of which 81.8% were females. The mean age of the participants was 39.98±12.5 years and a range of 15-65 years. About 27.3% of the respondents didn’t know the correct number and position of the kidney. 65% didn’t know any risk factor for kidney disease while 4.5% and 1.5% could mention hypertension and diabetes mellitus.

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Management of End Stage Renal Disease-Bangladesh Perspective

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01407010108 ◽

2014 ◽

Vol 7 (1) ◽

pp. 108-112 ◽

Cited By ~ 5

Author(s):

Harun Ur Rashid

Keyword(s):

Renal Disease ◽

Low Income ◽

End Stage Renal Disease ◽

Future Perspective ◽

Middle Income ◽

Middle Income Countries ◽

Initial Stage ◽

Per Capita ◽

Stage Renal Disease ◽

End Stage

End stage renal disease (ESRD) is an important cause of morbidity and mortality throughout the world. The treatment of renal replacement therapy (RRT) for patients with ESRD is expensive. There is a direct relationship between per capita income and treatment of ESRD. Eighty five per cent of the world’s population lives in low income or middle-income countries, where the mortality is highest in patients with chronic kidney disease. The future perspective is not satisfactory for Bangladesh where treatment of ESRD is out of reach for majority of people. Effort should made for prevention and treatment of CKD at an initial stage of disease.

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