International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean

Aminu K Bello; Mark McIsaac; Ikechi G Okpechi; David W Johnson; Vivekanand Jha; David C H Harris; Syed Saad; Deenaz Zaidi; Mohamed A Osman; Feng Ye; Meaghan Lunney; Kailash Jindal; Scott Klarenbach; Kamyar Kalantar-Zadeh; Csaba P Kovesdy; Rulan S Parekh; Bhanu Prasad; Maryam Khan; Parnian Riaz; Marcello Tonelli; Myles Wolf; Adeera Levin; ISN North America and the Caribbean Regional Board

doi:10.1016/j.kisu.2021.01.001

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean

Kidney Int Suppl (2011). 2021 May;11(2):e66-e76. doi: 10.1016/j.kisu.2021.01.001. Epub 2021 Apr 12.

Authors

Aminu K Bello¹, Mark McIsaac¹, Ikechi G Okpechi^{2

3

4}, David W Johnson^{5

6

7}, Vivekanand Jha^{8

9

10}, David C H Harris¹¹, Syed Saad², Deenaz Zaidi², Mohamed A Osman¹², Feng Ye², Meaghan Lunney¹³, Kailash Jindal¹, Scott Klarenbach¹, Kamyar Kalantar-Zadeh¹⁴, Csaba P Kovesdy¹⁵, Rulan S Parekh¹⁶, Bhanu Prasad¹⁷, Maryam Khan¹⁸, Parnian Riaz¹, Marcello Tonelli^{19

20}, Myles Wolf²¹, Adeera Levin²²; ISN North America and the Caribbean Regional Board

Affiliations

¹ Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.
² Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
⁴ Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
⁵ Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁶ Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁷ Translation Research Institute, Brisbane, Queensland, Australia.
⁸ George Institute for Global Health, University of New South Wales, New Delhi, India.
⁹ School of Public Health, Imperial College, London, UK.
¹⁰ Manipal Academy of Higher Education, Manipal, India.
¹¹ Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.
¹² Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
¹⁴ Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, California, USA.
¹⁵ Division of Nephrology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
¹⁶ Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Section of Nephrology, Department of Medicine, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada.
¹⁸ Faculty of Science, University of Alberta, Edmonton, Alberta, Canada.
¹⁹ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁰ Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada.
²¹ Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
²² Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

The International Society of Nephrology established the Global Kidney Health Atlas project to define the global capacity for kidney replacement therapy and conservative kidney care, and this second iteration was to describe the availability, accessibility, quality, and affordability of kidney failure (KF) care worldwide. This report presents results for the International Society of Nephrology North America and the Caribbean region. Relative to other regions, the North America and Caribbean region had better infrastructure and funding for health care and more health care workers relative to the population. Various essential medicines were also more available and accessible. There was substantial variation in the prevalence of treated KF in the region, ranging from 137.4 per million population (pmp) in Jamaica to 2196 pmp in the United States. A mix of public and private funding systems cover costs for nondialysis chronic kidney disease care in 60% of countries and for dialysis in 70% of countries. Although the median number of nephrologists is 18.1 (interquartile range, 15.3-29.5) pmp, which is approximately twice the global median of 9.9 (interquartile range, 1.2-22.7) pmp, some countries reported shortages of other health care workers. Dialysis was available in all countries, but peritoneal dialysis was underutilized and unavailable in Barbados, Cayman Islands, and Turks and Caicos. Kidney transplantation was primarily available in Canada and the United States. Economic factors were the major barriers to optimal KF care in the Caribbean countries, and few countries in the region have chronic kidney disease-specific national health care policies. To address regional gaps in KF care delivery, efforts should be directed toward augmenting the workforce, improving the monitoring and reporting of kidney replacement therapy indicators, and implementing noncommunicable disease and chronic kidney disease-specific policies in all countries.

Keywords: chronic kidney disease; dialysis; funding; kidney failure; kidney registries; workforce.

Publication types

Review