2018-02-01, Bello, Aminu K., Alrukhaimi, Mona, Ashuntantang, Gloria E., Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Braam, Branko, Feehally, John, Harris, David C., Jha, Vivekanand, Jindal, Kailash, Johnson, David W., Kalantar-Zadeh, Kamyar, Kazancioglu, RÜMEYZA, Kerr, Peter G., Lunney, Meaghan, Olanrewaju, Timothy Olusegun, Osman, Mohamed A., Perl, Jeffrey, Rashid, Harun Ur, Rateb, Ahmed, Rondeau, Eric, Sakajiki, Aminu Muhammad, Samimi, Arian, Sola, Laura, Tchokhonelidze, Irma, Wiebe, Natasha, Yang, Chih-Wei, Ye, Feng, Zemchenkov, Alexander, Zhao, Ming-hui, Levin, Adeera, KAZANCIOĞLU, RÜMEYZA

Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.

2018-02-01, Okpechi, Ikechi G., Alrukhaimi, Mona, Ashuntantang, Gloria E., Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Braam, Branko, Feehally, John, Harris, David C., Jha, Vivekanand, Jindal, Kailash, Johnson, David W., Kalantar-Zadeh, Kamyar, Kazancioglu, RÜMEYZA, Levin, Adeera, Lunney, Meaghan, Olanrewaju, Timothy Olusegun, Perkovic, Vlado, Perl, Jeffrey, Rashid, Harun Ur, Rondeau, Eric, Salako, Babatunde lawal, Samimi, Arian, Sola, Laura, Tchokhonelidze, Irma, Wiebe, Natasha, Yang, Chih-Wei, Ye, Feng, Zemchenkov, Alexander, Zhao, Ming-hui, Bello, Aminu K., KAZANCIOĞLU, RÜMEYZA

Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, n = 31), with the lowest figures obtained from Africa (7%, n = 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials. Overall, formal training to conduct clinical trials was inadequate for physicians (46%, n = 53) and even lower for nonphysicians, research assistants, and associates in clinical trials (34%, n = 39). There was also diminished availability of workforce and funding to conduct observational cohort studies in nephrology, and participation in highly specialized transplant trials was low in many regions. Overall, the availability of infrastructure (bio-banking and facilities for storage of clinical trial medications) was low, and it was lowest in low-income and lower-middle-income countries. Ethics approval for study conduct was mandatory in 91% (n = 106) of countries and regions, and 62% (n = 66) were reported to have institutional committees. Challenges with obtaining timely approval for a study were reported in 53% (n = 61) of regions but the challenges were similar across these regions. A potential limitation is the possibility of over-reporting or under-reporting due to social desirability bias. This study highlights some of the major challenges for participating in and conducting kidney research and offers suggestions for improving global kidney research.

2018-02-01, Htay, Htay, Alrukhaimi, Mona, Ashuntantang, Gloria E, braum, branko, gharbiğ, mohammed benghanem, Feehally, John, Harris, David C, KAZANCIOĞLU, RÜMEYZA, KAZANCIOĞLU, RÜMEYZA

Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world's population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.