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JAMA. 2017 May 9;317(18):1864-1881. doi: 10.1001/jama.2017.4046.

Assessment of Global Kidney Health Care Status.

Author information

Department of Medicine, University of Alberta, Edmonton, Canada.
Division of Nephrology, University of British Columbia, Vancouver, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada4Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
University Hospitals of Leicester, University of Leicester, Leicester, England.
Centre for Transplantation and Renal Research, University of Sydney at Westmead Hospital, Sydney, Australia.
Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia10Translational Research Institute, Brisbane, Australia11Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.



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


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.


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.

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