Burden, access, and disparities in kidney disease

Abstract

This article was published in Kidney International volume 95, pages 242-248, https://doi.org/10.1016/j.kint.2018.11.007, Copyright World Kidney Day 2019 Steering Committee (2019) and is reprinted concurrently in several journals. The articles cover identical concepts and wording, but vary in minor stylistic and spelling changes, detail, and length of manuscript in keeping with each journal's style. Any of these versions may be used in citing this article. Note that all authors contributed equally to the conception, preparation, and editing of the manuscript. Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.

Figure 1. Health care services for identification and management of chronic kidney disease by country income level. (A) Primary care (i.e., basic health facilities at community levels [e.g., clinics, dispensaries, and small local hospitals]). (B) Secondary/specialty care (i.e., health facilities at a level higher than primary care [e.g., clinics, hospitals, and academic centers]). eGFR: estimated glomerular filtration rate; HbA1C: glycated hemoglobin; UACR: urine albumin-to-creatinine ratio; UPCR: urine protein-to-creatinine ratio. Data from Bello et al. (4) and Htay et al. (42)

Figure 2. Nephrologist availability (density per million population) compared with physician, nursing, and pharmaceutical personnel availability by country income level. Pharmaceutical personnel include pharmacists, pharmaceutical assistants, and pharmaceutical technicians. Nursing and midwifery personnel include professional nurses, professional midwives, auxiliary nurses, auxiliary midwives, enrolled nurses, enrolled midwives, and related occupations such as dental nurses. A logarithmic scale was used for the x-axis [log(x+1)] because of the large range in provider density. Data from Bello et al. (4), Osman et al. (43), and the World Health Organization (for pharmaceutical personnel: http://apps.who.int/gho/data/view.main.PHARMS and http://apps.who.int/gho/data/node.main-amro.HWF?lang=en, for nursing and midwifery personnel: http://apps.who.int/gho/data/view.main.NURSES, for physicians: http://apps.who.int/gho/data/view.main.92000) (44).