Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

Abstract

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.

Keywords: acute kidney injury and chronic kidney disease care; funding for health care; funding for medications; global health care; health care service provision; renal replacement therapy.

Figure 1

Health care services for the identification and management of chronic kidney disease in primary care level by World Bank income groups. Capacities of primary health care services for chronic kidney disease care are reported as percentages of countries with particular services in each income group. eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; UACR, urine albumin to creatinine ratio; UPCR, urine protein to creatinine ratio.

Figure 2

Health care services for the identification and management of chronic kidney disease in secondary or tertiary care levels by World Bank income groups. Capacities of secondary or tertiary health care services for chronic kidney disease care are reported as percentages of countries with particular services in each income group. eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; UACR, urine albumin to creatinine ratio; UPCR, urine protein to creatinine ratio.

Figure 3

Capacity for provision of renal replacement therapy services across countries classified by World Bank income groups. Capacities for renal replacement therapy services across countries are reported as percentages of countries with availability of particular services in each income group.

Figure 4

Funding for different renal replacement therapy services across all countries. Funding structures for different renal replacement therapy services across all countries in the study are reported as a percentage of countries with a particular type of funding. govt, government; HD, hemodialysis; NGOs, nongovernmental organizations; PD, peritoneal dialysis.

Figure 5

Funding of medications for patients with kidney diseases. Funding of medications for patients with kidney diseases are reported as percentage of countries with a particular type of funding. CKD, chronic kidney disease; govt, government; NGOs, nongovernmental organizations.