Landscape of kidney replacement therapy provision in low- and lower-middle income countries: A multinational study from the ISN-GKHA

Victoria Nkunu; Somkanya Tungsanga; Hassane M Diongole; Abdulshahid Sarki; Silvia Arruebo; Fergus J Caskey; Sandrine Damster; Jo-Ann Donner; Vivekanand Jha; Adeera Levin; Masaomi Nangaku; Syed Saad; Feng Ye; Ikechi G Okpechi; Aminu K Bello; David W Johnson; Marcello Tonelli

doi:10.1371/journal.pgph.0003979

Landscape of kidney replacement therapy provision in low- and lower-middle income countries: A multinational study from the ISN-GKHA

PLOS Glob Public Health. 2024 Dec 2;4(12):e0003979. doi: 10.1371/journal.pgph.0003979. eCollection 2024.

Authors

Victoria Nkunu¹, Somkanya Tungsanga^{2

3}, Hassane M Diongole^{4

5}, Abdulshahid Sarki⁶, Silvia Arruebo⁷, Fergus J Caskey⁸, Sandrine Damster⁷, Jo-Ann Donner⁷, Vivekanand Jha^{9

10

11}, Adeera Levin¹², Masaomi Nangaku¹³, Syed Saad², Feng Ye², Ikechi G Okpechi^{2

14

15}, Aminu K Bello², David W Johnson^{16

17

18

19}, Marcello Tonelli^{20

21}

Affiliations

¹ Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
² Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
³ Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴ Division of Nephrology, Department of Medicine, National Hospital Zinder, Zinder, Niger.
⁵ Faculty of Health Sciences, University of Zinder, Zinder, Niger.
⁶ Nephrology Unit, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria.
⁷ The International Society of Nephrology, Brussels, Belgium.
⁸ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁹ George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India.
¹⁰ School of Public Health, Imperial College, London, United Kingdom.
¹¹ Manipal Academy of Higher Education, Manipal, India.
¹² Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹³ Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
¹⁴ Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
¹⁵ Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
¹⁶ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹⁷ Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹⁸ Translational Research Institute, Brisbane, Queensland, Australia.
¹⁹ Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia.
²⁰ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²¹ Canada and Pan-American Health Organization, World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada.

Abstract

In low- and lower-middle-income countries (LLMICs), delivering equitable kidney care presents substantial challenges, resulting in significant disparities in disease management and treatment outcomes for people with kidney failure. This comprehensive report leveraged data from the International Society of Nephrology-Global Kidney Health Atlas (ISN-GKHA), to provide a detailed update on the landscape of kidney replacement therapy (KRT) in LLMICs. Among the 65 participating LLMICs, reimbursement for KRT (publicly funded by the government and free at the point of delivery) was available in 28%, 15%, and 8% for hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT), respectively. Additionally, while 56% and 28% of LLMICs reported the capacity to provide quality HD and PD, only 41% reported accessibility to chronic dialysis, defined as >50% of the national population being able to access KRT, and a mere 5% LLMICs reported accessibility to KT. Workforce shortages in nephrology further compound these challenges. Kidney registries and comprehensive policies for non-communicable diseases and chronic kidney disease care were limited in LLMICs. A comprehensive and cost-effective approach is crucial to address these challenges. Collaboration at global, regional, country, and individual levels is essential to enhance the quality of kidney care across LLMICs.

Copyright: © 2024 Nkunu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The ISN-GKHA work was supported by the International Society of Nephrology (ISN) (grant RES0033080 to AKB at the University of Alberta). The author(s) received no specific funding for this work, except for SA, SD, and JD, who are employees of the ISN; the ISN provided support to SA, SD, and JD in the form of salaries. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.