Dialysis funding, eligibility, procurement, and protocols in low- and middle-income settings: results from the International Society of Nephrology collection survey

Abstract

Dialysis provisions and end-stage kidney disease (ESKD) care represents an important challenge, particularly in low-resource settings. The purpose of this project was to survey nephrologists from low- and lower middle-income countries about their experiences in the following domains: (i) Dialysis funding and eligibility; (ii) dialysis-procurement mechanisms; (iii) clinical protocols for dialysis; (iv) monitoring of dialysis outcomes; and (v) barriers to care for ESKD. One hundred and twenty responses from 31 low- and middle-income countries, from 8 ISN regions, were included in the analysis. When stratified by World Bank country income status, responses were received from 7 low-income countries, 12 lower middle-income countries, and 12 upper middle-income countries. Eighty-eight documents from 18 countries were uploaded, including country or institutional guidelines, protocols, and standard operating procedures. The International Society of Nephrology aims to develop a set of guidance documents that put forward a considered approach to dialysis provisions and ESKD care within resource limitations. As an initial step in this project, local practitioners from low-resource settings were surveyed about their experiences with dialysis funding, eligibility, procurement and their use of guidance documents, and how practices and procedures may have been developed with adaptations to the local circumstances. In this manuscript we describe the methodology and the main findings from the survey using an integrated quantitative and qualitative approach.

Keywords: chronic kidney disease; dialysis; end-stage kidney disease; funding; hemodialysis; peritoneal dialysis.

Figure 1

Distribution of survey responses from low- and middle-income countries; 120 respondents from 31 countries responded to the survey. Upper middle–, lower middle–, and low-income countries are highlighted in red. Map created using mapchart.net.

Figure 2

Numbers of patients receiving hemodialysis or peritoneal dialysis in respondents’ institutions. Distribution of numbers of patients receiving hemodialysis or peritoneal dialysis followed by survey respondents.

Figure 3

Thematic diagram summarizing the key themes, domains, and examples of the mixed-research approach. ESKD, end-stage kidney disease.

Figure 4

Most common barriers to end-stage kidney disease care cited by respondents. Frequency of reporting of specific barriers by respondents in free-text entries to the survey. OOP, out-of-pocket; PD, peritoneal dialysis; Tx, transplantation.