Global case studies for chronic kidney disease/end-stage kidney disease care

Abstract

The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities. This collection of case studies is from 15 countries from around the world and offers valuable learning examples from a variety of contexts. The variability in approaches may be explained by country differences in burden of disease, available human or financial resources, income status, and cost structures. In addition, cultural considerations, political context, and competing interests from other stakeholders must be considered. Although the approaches taken have often varied substantially, a common theme is the potential benefits of multistakeholder engagement aimed at improving the availability and scope of integrated kidney care.

Keywords: chronic kidney disease; dialysis; end-stage kidney disease; transplantation.

Figure 1

Relationship between the basic concept of Data Health Plan and chronic kidney disease (CKD), Japan. Reproduced with permission from [Proposal to achieve a decline in the number of dialysis initiations due to lifestyle related diseases—early detection and prevention of onset and progression of CKD]. Nihon Jinzo Gakkai Shi. 2016;58:429–475 [in Japanese]. Copyright © 2016 Japanese Society of Nephrology.

Figure 2

Incidence rates of dialysis by sex and age group in Japan, 2005–2015. Reproduced with permission from Wakasugi M, Narita I. Evaluating the impact of CKD initiatives on the incidence of dialysis in Japan. Jpn J Nephrol. 2018;60:41–49. Copyright © 2018 Japanese Society of Nephrology and the Japanese Journal of Nephrology.

Figure 3

National Integrated Health System (SNIS in Spanish) financial sources in Uruguay. Reproduced with permission from Ministerio de Salud Pública. La Construcción del Sistema Nacional Integrado de Salud. 2005–2009. Available at: http://www.paho.org/hq/dmdocuments/2010/construccion_sist_nac_integrado_salud_2005-2009-uruguay.pdf. Accessed March 18, 2018.

Figure 4

Providing dialysis to meet Malaysian needs. Dialysis treatment by sector (per million population [pmp]), 1980–2016.^,, BAKTI, Badan Amal dan Kebajikan Tenaga Isteri-Isteri Menteri dan Timbalan Menteri (Charitable and welfare bodies of the wives of Ministers and deputy Ministers); HD, hemodialysis; JPA, Jabatan Perkhidmatan Awam (Public Service Department) (civil servants and their dependants would be reimbursed by the government); MOH, Ministry of Health, Malaysia (public health care services are funded through general taxation, with annual health budgets allocated by the Ministry of Finance to the MOH); NGO, nongovernmental organization (NGOs are providing support to access dialysis by either providing some of these services [e.g., dialysis services by the National Kidney Foundation {NKF}], subsidizing part of the payment, or assisting in appealing for public donations [e.g., NKF]); SOCSO, Social Security Organization (a government-run social insurance body that receives mandatory contributions from private-sector employees earning below US$950 per month); YKN, Yayasan Kebajikan Negara; Zakat, state-run Islamic social welfare organizations reimburse eligible patients for certain treatments and dialysis, which was included as a rehabilitation therapy.

Figure 5

Number of kidney transplantation cases in South Korea. Data from Ahn HJ, Kim HW, Han M, et al. Changing patterns of foreigner transplants in Korea and overseas organ transplants among Koreans. Transplantation. 2018;102:310–317. Copyright © 2018 Wolters Kluwer Health, Inc.

Figure 6

Relationship between the number of overseas organ transplantation cases and the number of deceased organ donors in South Korea. Doha: Doha, Qatar; DOI, Declaration of Istanbul; IOPO, independent organ procurement organization; KODA, Korea Organ Donation Agency; KOTRY, Korean Organ Transplantation Registry. Reproduced with permission from Ahn HJ, Kim HW, Han M, et al. Changing patterns of foreigner transplants in Korea and overseas organ transplants among Koreans. Transplantation. 2018;102:310–317. Copyright © 2018 Wolters Kluwer Health, Inc.

Figure 7

Model for kidney transplantation in Ghana. HDU, high-dependency unit; ICU, intensive care unit.

Figure 8

Strengths, weaknesses, opportunities, and threats (SWOT) analysis of chronic kidney disease (CKD)/end-stage kidney disease (ESKD) strategies.