BMJ Open (Jul 2021)
Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey
- Fergus Caskey,
- Vlado Perkovic,
- David Johnson,
- Vladimir Tesar,
- Adeera Levin,
- Csaba Kovesdy,
- Kamyar Kalantar-Zadeh,
- Vivekanand Jha,
- Peter Kerr,
- Mohamed A Osman,
- Natasha Wiebe,
- Ikechi G Okpechi,
- Kailash Jindal,
- Marcello Tonelli,
- Scott Klarenbach,
- Eric Rondeau,
- Meaghan Lunney,
- Feng Ye,
- Ezequiel Bellorin-Font,
- Mohammed Benghanem Gharbi,
- Mohammad Ghnaimat,
- Shahrzad Ossareh,
- Jeffrey Perl,
- Emily See,
- Syed Saad,
- Laura Sola,
- Irma Tchokhonelidze,
- Rumeyza Turan Kazancioglu,
- Angela Yee-Moon Wang,
- Chih-Wei Yang,
- Alexander Zemchenkov,
- Kitty J Jager,
- John Feehally,
- Sara Davison,
- Donal O'Donoghue,
- Gloria Ashuntantang,
- Emily Yeung,
- AK Bello,
- Valerie Luyckx,
- Brendon Neuen,
- Harun Ur Rashid,
- Minhui Zhao,
- David CH Harris
Affiliations
- Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
- Vlado Perkovic
- The George Institute for Global Health, Newtown, New South Wales, Australia
- David Johnson
- Centre for Kidney Disease Research, The University of Queensland, Saint Lucia, Queensland, Australia
- Vladimir Tesar
- Department of Nephrology, Charles University, Praha, Czech Republic
- Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Csaba Kovesdy
- Nephrology, Memphis VA Medical Center, Memphis, Tennessee, USA
- Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
- Vivekanand Jha
- George Institute for Global Health, New Dehli, India
- Peter Kerr
- Department of Nephrology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Mohamed A Osman
- Medicine, University of Alberta, Edmonton, Alberta, Canada
- Natasha Wiebe
- Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Ikechi G Okpechi
- Medicine, University of Cape Town, Cape Town, South Africa
- Kailash Jindal
- Medicine, University of Alberta, Edmonton, Alberta, Canada
- Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Scott Klarenbach
- Medicine, University of Alberta, Edmonton, Alberta, Canada
- Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Assistance Publique—Hopitaux de Paris, Paris, France
- Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Feng Ye
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Ezequiel Bellorin-Font
- Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri, USA
- Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, University of Hassan II Casablanca Faculty of Science Ain Chock, Casablanca, Morocco
- Mohammad Ghnaimat
- Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
- Shahrzad Ossareh
- Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
- Jeffrey Perl
- Department of Nephrology, St Michael`s Hospital, Toronto, Ontario, Canada
- Emily See
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
- Syed Saad
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
- Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
- Rumeyza Turan Kazancioglu
- Division of Nephrology, Bezmialem Vakif Universitesi, Istanbul, Turkey
- Angela Yee-Moon Wang
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
- Chih-Wei Yang
- Kidney Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Alexander Zemchenkov
- Department of Internal Disease and Nephrology, North-Western State Medical University named after I I Mechnikov, Sankt-Peterburg, Russia
- Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- John Feehally
- Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, UK
- Sara Davison
- Division of Nephrology and Immunology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Donal O'Donoghue
- Salford Royal Hospitals NHS Trust, Salford, UK
- Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
- Emily Yeung
- Monash Health, Clayton, Victoria, Australia
- AK Bello
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Valerie Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich Institute of Biomedical Ethics History of Medicine, Zurich, Switzerland
- Brendon Neuen
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
- Minhui Zhao
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- David CH Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- DOI
- https://doi.org/10.1136/bmjopen-2020-047245
- Journal volume & issue
-
Vol. 11,
no. 7
Abstract
Objectives The 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.Setting A cross-sectional global survey.Participants Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.Primary outcomes Primary 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.Results 160 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.Conclusion Significant 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.
