Person: KAZANCIOĞLU, RÜMEYZA
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Publication Open Access International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Eastern and Central Europe(2021-05-01T00:00:00Z) Dębska-Ślizień, Alicja; Bello, Aminu K.; Johnson, David W.; Jha, Vivekanand; Harris, David C.H.; Levin, Adeera; Tonelli, Marcello; Saad, Syed; Zaidi, Deenaz; Osman, Mohamed A.; Ye, Feng; Khan, Maryam; Lunney, Meaghan; Okpechi, Ikechi G.; Turan Kazancioglu, Rümeyza; KAZANCIOĞLU, RÜMEYZAProvision of adequate kidney care for patients with chronic kidney disease or kidney failure (KF) is costly and requires extensive resources. There is an inequality in the global distribution of wealth and resources needed to provide this care. In this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we present data for countries in Eastern and Central Europe. In the region, the median prevalence of chronic kidney disease was 13.15% and treated KF was 764 per million population, respectively, slightly higher than the global median of 759 per million population. In most countries in the region, over 90% of dialysis patients were on hemodialysis and patients with a functioning graft represented less than one-third of total patients with treated KF. The median annual costs for maintenance hemodialysis were close to the global median, and public funding provided nearly universal coverage of the costs of kidney replacement therapy. Nephrologists were primarily responsible for KF care. All countries had the capacity to provide long-term hemodialysis, and 95% had the capacity to provide peritoneal dialysis. Home hemodialysis was generally not available. Kidney transplantation and conservative care were available across most of the region. Almost all countries had official dialysis and transplantation registries. Eastern and Central Europe is a region with a high burden of chronic kidney disease and variable capacity to deal with it. Insufficient funding and workforce shortages coupled with increasing comorbidities among aging patients and underutilization of cost-effective dialysis therapies such as peritoneal dialysis and kidney transplantation may compromise the quality of care for patients with KF. Some workforce shortages could be addressed by improving the organization of nephrological care in some countries of the region.Publication Open Access Global overview of health systems oversight and financing for kidney care(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, RÜMEYZAReliable 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.Publication Open Access Availability, coverage, and scope of health information systems for kidney care across world countries and regions.(2020-12-22T00:00:00Z) See, Emily J; Bello, Aminu K; Levin, Adeera; Lunney, Meaghan; Osman, Mohamed A; Ye, Feng; Ashuntantang, Gloria E; Bellorin-Font, Ezequiel; Benghanem Gharbi, Mohammed; Davison, Sara; Ghnaimat, Mohammad; Harden, Paul; Htay, Htay; Jha, Vivekanand; Kalantar-Zadeh, Kamyar; Kerr, Peter G; Klarenbach, Scott; Kovesdy, Csaba P; Luyckx, Valerie; Neuen, Brendon; O'Donoghue, Donal; Ossareh, Shahrzad; Perl, Jeffrey; Rashid, Harun Ur; Rondeau, Eric; Syed, Saad; Sola, Laura; Tchokhonelidze, Irma; Tesar, Vladimir; Tungsanga, Kriang; Kazancioglu, Rümeyza; Wang, Angela Yee-Moon; Yang, Chih-Wei; Zemchenkov, Alexander; Zhao, Ming-Hui; Jager, Kitty J; Caskey, Fergus; Perkovic, Vlado; Jindal, Kailash K; Okpechi, Ikechi G; Tonelli, Marcello; Feehally, John; Harris, David C; Johnson, David W; KAZANCIOĞLU, RÜMEYZABackground. Health information systems (HIS) are fundamental tools for the surveillance of health services, estimation of disease burden and prioritization of health resources. Several gaps in the availability of HIS for kidney disease were highlighted by the first iteration of the Global Kidney Health Atlas. Methods. As part of its second iteration, the International Society of Nephrology conducted a cross-sectional global survey between July and October 2018 to explore the coverage and scope of HIS for kidney disease, with a focus on kidney replacement therapy (KRT). Results. Out of a total of 182 invited countries, 154 countries responded to questions on HIS (85% response rate). KRT registries were available in almost all high-income countries, but few low-income countries, while registries for non-dialysis chronic kidney disease (CKD) or acute kidney injury (AKI) were rare. Registries in high-income countries tended to be national, in contrast to registries in low-income countries, which often operated at local or regional levels. Although cause of end-stage kidney disease, modality of KRT and source of kidney transplant donors were frequently reported, few countries collected data on patient-reported outcome measures and only half of low-income countries recorded process-based measures. Almost no countries had programs to detect AKI and practices to identify CKD-targeted individuals with diabetes, hypertension and cardiovascular disease, rather than members of high-risk ethnic groups. Conclusions. These findings confirm significant heterogeneity in the global availability of HIS for kidney disease and highlight important gaps in their coverage and scope, especially in low-income countries and across the domains of AKI, non-dialysis CKD, patient-reported outcomes, process-based measures and quality indicators for KRT service delivery.Publication Open Access Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology(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, RÜMEYZADue 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.Publication Open Access Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis(2020-03-01T00:00:00Z) Sola, Laura; Levin, Nathan W.; Johnson, David W.; Pecoits-Filho, Roberto; Aljubori, Harith M.; Chen, Yuqing; Claus, Stefaan; Collins, Allan; Cullis, Brett; Feehally, John; Harden, Paul N.; Hassan, Mohamed H.; Ibhais, Fuad; Kalantar-Zadeh, Kamyar; Levin, Adeera; Saleh, Abdulkarim; Schneditz, Daneil; Tchokhonelidze, Irma; Turan Kazancioglu, RÜMEYZA; Twahir, Ahmed; Walker, Robert; Were, Anthony J.O.; Yu, Xueqing; Finkelstein, Fredric O.; KAZANCIOĞLU, RÜMEYZASubstantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries. Keywords: hemodialysis; minimum safety standards; peritoneal dialysis; quality of care.Publication Open Access Global nephrology workforce: gaps and opportunities toward a sustainable kidney care system(2018-02-01) Osman, Mohamed A.; Alrukhaimi, Mona; Ashuntantang, Gloria E.; Bellorin-Font, Ezequiel; Gharbi, Mohammed Benghanem; Braam, Branko; Courtney, Mark; Feehally, John; Harris, David C.; Jha, Vivekanand; Jindal, Kailash; Johnson, David W.; Kalantar-Zadeh, Kamyar; Kazancioglu, RÜMEYZA; Klarenbach, Scott; Levin, Adeera; Lunney, Meaghan; Okpechi, Ikechi G.; Olanrewaju, Timothy Olusegun; 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, RÜMEYZAThe health workforce is the cornerstone of any health care system. An adequately trained and sufficiently staffed workforce is essential to reach universal health coverage. In particular, a nephrology workforce is critical to meet the growing worldwide burden of kidney disease. Despite some attempts, the global nephrology workforce and training capacity remains widely unknown. This multinational cross-sectional survey was part of the Global Kidney Health Atlas project, a new initiative administered by the International Society of Nephrology (ISN). The objective of this study was to address the existing global nephrology workforce and training capacity. The questionnaire was administered online, and all data were analyzed and presented by ISN regions and World Bank country classification. Overall, 125 United Nations member states responded to the entire survey, with 121 countries responding to survey questions pertaining to the nephrology workforce. The global nephrologist density was 8.83 per million population (PMP); high-income countries reported a nephrologist density of 28.52 PMP compared with 0.31 PMP in low-income countries. Similarly, the global nephrologist trainee density was 1.87 PMP; high-income countries reported a 30 times greater nephrology trainee density than low-income countries (6.03 PMP vs. 0.18 PMP). Countries reported a shortage in all care providers in nephrology. A nephrology training program existed in 79% of countries, ranging from 97% in high-income countries to 41% in low-income countries. In countries with a training program, the majority (86%) of programs were 2 to 4 years, and the most common training structure (56%) was following general internal medicine. We found significant variation in the global density of nephrologists and nephrology trainees and shortages in all care providers in nephrology; the gap was more prominent in low-income countries, particularly in African and South Asian ISN regions. These findings point to significant gaps in the current nephrology workforce and opportunities for countries and regions to develop and maintain a sustainable workforce.Publication Open Access Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide.(2020-12-15T00:00:00Z) Lunney, Meaghan; Bello, Aminu K; Levin, Adeera; Tam-Tham, Helen; Thomas, Chandra; Osman, Mohamed A; Ye, Feng; Bellorin-Font, Ezequiel; Benghanem Gharbi, Mohammed; Ghnaimat, Mohammad; Htay, Htay; Cho, Yeoungjee; Jha, Vivekanand; Ossareh, Shahrzad; Rondeau, Eric; Sola, Laura; Tchokhonelidze, Irma; Tesar, Vladimir; Tungsanga, Kriang; Kazancioglu, Rümeyza; Wang, Angela Yee-Moon; Yang, Chih-Wei; Zemchenkov, Alexander; Zhao, Ming-Hui; Jager, Kitty J; Jindal, Kailash K; Okpechi, Ikechi G; Brown, Edwina A; Brown, Mark; Tonelli, Marcello; Harris, David C; Johnson, David W; Caskey, Fergus J; Davison, Sara N; KAZANCIOĞLU, RÜMEYZAPublication Open Access Global coverage of health information systems for kidney disease: availability, challenges, and opportunities for development(2018-02-01) See , Emily J.; Alrukhaimi , Mona; Ashuntantang, Gloria E.; Bello, Aminu K.; Bellorin-Font, Ezequiel; Gharbi, Mohammed Benghanem; Braam, Branko; Feehally, John; Harris, David C.; Jha, Vivekanand; Jindal, Kailash; Kalantar-Zadeh , Kamyar; Kazancioglu, RÜMEYZA; Levin, Adeera; Lunney, Meaghan; Okpechi, Ikechi G.; Olanrewaju , Timothy Olusegun; Osman, Mohamed A.; Perl, Jeffrey; Qarni, Bilal; Rashid, Harun Ur; Rateb, Ahmed; Rondeau, Eric; Samimi, Arian; Sikosana, Majid L. N.; Sola, Laura; Tchokhonelidze, Irma; Wiebe, Natasha; Yang, Chih-Wei; Ye, Feng; Zemchenkov, Alexander; Zhao, Ming-hui; Johnson, David W.; KAZANCIOĞLU, RÜMEYZADevelopment and planning of health care services requires robust health information systems to define the burden of disease, inform policy development, and identify opportunities to improve service provision. The global coverage of kidney disease health information systems has not been well reported, despite their potential to enhance care. As part of the Global Kidney Health Atlas, a cross-sectional survey conducted by the International Society of Nephrology, data were collected from 117 United Nations member states on the coverage and scope of kidney disease health information systems and surveillance practices. Dialysis and transplant registries were more common in high-income countries. Few countries reported having nondialysis chronic kidney disease and acute kidney injury registries. Although 62% of countries overall could estimate their prevalence of chronic kidney disease, less than 24% of low-income countries had access to the same data. Almost all countries offered chronic kidney disease testing to patients with diabetes and hypertension, but few to high-risk ethnic groups. Two-thirds of countries were unable to determine their burden of acute kidney injury. Given the substantial heterogeneity in the availability of health information systems, especially in low-income countries and across nondialysis chronic kidney disease and acute kidney injury, a global framework for prioritizing development of these systems in areas of greatest need is warranted.Publication Open Access Guidelines, policies, and barriers to kidney care: findings from a global survey(2018-02-01) Lunney, Meaghan; Alrukhaimi, Mona; Ashuntantang, Gloria E.; Bello, Aminu K.; Bellorin-Font, Ezequiel; Gharbi, Mohammed Benghanem; Jha, Vivekanand; Johnson, David W.; Kalantar-Zadeh, Kamyar; Kazancioglu, RÜMEYZA; Olah, Michelle E.; Olanrewaju, Timothy Olusegun; Osman, Mohamed A.; Parpia, Yasin; Perl, Jeffrey; Rashid, Harun Ur; Rateb, Ahmed; Rondeau, Eric; Sola, Laura; Tchokhonelidze, Irma; Tonelli, Marcello; Wiebe, Natasha; Wirzba, Isaac; Yang, Chih-Wei; Ye, Feng; Zemchenkov, Alexander; Zhao, Ming-hui; Levin, Adeera; KAZANCIOĞLU, RÜMEYZAAn international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.Publication Open Access Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey.(2021-07-09T00:00:00Z) Yeung, Emily; Bello, A K; Levin, Adeera; Lunney, Meaghan; Osman, Mohamed A; Ye, Feng; Ashuntantang, Gloria; Bellorin-Font, Ezequiel; Benghanem Gharbi, Mohammed; Davison, Sara; Ghnaimat, Mohammad; Harden, Paul; Jha, Vivekanand; Kalantar-Zadeh, Kamyar; Kerr, Peter; Klarenbach, Scott; Kovesdy, Csaba; Luyckx, Valerie; Neuen, Brendon; O'Donoghue, Donal; Ossareh, Shahrzad; Perl, Jeffrey; Ur Rashid, Harun; Rondeau, Eric; See, Emily; Saad, Syed; Sola, Laura; Tchokhonelidze, Irma; Tesar, Vladimir; Tungsanga, Kriang; Turan Kazancioglu, Rümeyza; Wang, Angela Yee-Moon; Wiebe, Natasha; Yang, Chih-Wei; Zemchenkov, Alexander; Zhao, Minhui; Jager, Kitty J; Caskey, Fergus; Perkovic, Vlado; Jindal, Kailash; Okpechi, Ikechi G; Tonelli, Marcello; Feehally, John; Harris, David Ch; Johnson, David; KAZANCIOĞLU, RÜMEYZA