Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

Meaghan Lunney¹, Aminu K Bello², Adeera Levin³, Helen Tam-Tham⁴, Chandra Thomas⁴, Mohamed A Osman⁵, Feng Ye², Ezequiel Bellorin-Font⁶, Mohammed Benghanem Gharbi⁷, Mohammad Ghnaimat⁸, Htay Htay⁹, Yeoungjee Cho^{10

11

12}, Vivekanand Jha^{13

14

15}, Shahrzad Ossareh¹⁶, Eric Rondeau^{17

18}, Laura Sola¹⁹, Irma Tchokhonelidze²⁰, Vladimir Tesar²¹, Kriang Tungsanga^{22

23}, Rumeyza Turan Kazancioglu²⁴, Angela Yee-Moon Wang²⁵, Chih-Wei Yang^{26

27}, Alexander Zemchenkov^{28

29}, Ming-Hui Zhao^{30

31

32

33}, Kitty J Jager³⁴, Kailash K Jindal², Ikechi G Okpechi^{35

36}, Edwina A Brown³⁷, Mark Brown³⁸, Marcello Tonelli^{4

39}, David C Harris⁴⁰, David W Johnson^{10

11

12}, Fergus J Caskey^{41

42}, Sara N Davison²

Affiliations

¹ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
² Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Division of Nephology and Hypertension, Saint Louis University, St. Louis, Missouri.
⁷ Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco.
⁸ Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan.
⁹ Department of Renal Medicine, Singapore General Hospital, Singapore.
¹⁰ Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.
¹¹ Translational Research Institute, Brisbane, Queensland, Australia.
¹² Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹³ George Institute for Global Health, University of New South Wales, New Delhi, India.
¹⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom.
¹⁵ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
¹⁶ Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
¹⁷ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.
¹⁸ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France and Sorbonne Université, Paris, France.
¹⁹ Dialysis Unit, Centro de Asistencia del Sindicato Médico del Uruguay - Institución de Asistencia Medica Privada de Profesionales (CASMU-IAMPP), Montevideo, Uruguay.
²⁰ Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
²¹ Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic.
²² Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
²³ Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Bhumirajanagarindra Kidney Institute, Bangkok, Thailand.
²⁴ Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey.
²⁵ Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
²⁶ Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.
²⁷ Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
²⁸ Department of Internal Diseases, Clinical Pharmacology, and Nephrology, North-Western State Medical University named after I. I. Mechnikov, St. Petersburg, Russia.
²⁹ Department of Nephrology and Dialysis, Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia.
³⁰ Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
³¹ Key Lab of Renal Disease, Ministry of Health of China, Beijing, China.
³² Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.
³³ Peking-Tsinghua Center for Life Sciences, Beijing, China.
³⁴ European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
³⁵ Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
³⁶ Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
³⁷ Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, England.
³⁸ Department of Renal Medicine, St George Hospital and University of New South Wales, Sydney, New South Wales, Australia.
³⁹ Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴⁰ Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
⁴¹ UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, United Kingdom and Population Health Sciences, University of Bristol, Bristol, United Kingdom.
⁴² Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, United Kingdom.

PMID: 33323461
PMCID: PMC7792657
DOI: 10.2215/CJN.09070620

Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

Meaghan Lunney et al. Clin J Am Soc Nephrol. 2020.

. 2020 Dec 31;16(1):79-87.

doi: 10.2215/CJN.09070620. Epub 2020 Dec 15.

Authors

Affiliations

¹ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
² Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Division of Nephology and Hypertension, Saint Louis University, St. Louis, Missouri.
⁷ Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco.
⁸ Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan.
⁹ Department of Renal Medicine, Singapore General Hospital, Singapore.
¹⁰ Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.
¹¹ Translational Research Institute, Brisbane, Queensland, Australia.
¹² Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹³ George Institute for Global Health, University of New South Wales, New Delhi, India.
¹⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom.
¹⁵ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
¹⁶ Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
¹⁷ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.
¹⁸ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France and Sorbonne Université, Paris, France.
¹⁹ Dialysis Unit, Centro de Asistencia del Sindicato Médico del Uruguay - Institución de Asistencia Medica Privada de Profesionales (CASMU-IAMPP), Montevideo, Uruguay.
²⁰ Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
²¹ Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic.
²² Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
²³ Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Bhumirajanagarindra Kidney Institute, Bangkok, Thailand.
²⁴ Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey.
²⁵ Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
²⁶ Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.
²⁷ Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
²⁸ Department of Internal Diseases, Clinical Pharmacology, and Nephrology, North-Western State Medical University named after I. I. Mechnikov, St. Petersburg, Russia.
²⁹ Department of Nephrology and Dialysis, Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia.
³⁰ Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
³¹ Key Lab of Renal Disease, Ministry of Health of China, Beijing, China.
³² Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.
³³ Peking-Tsinghua Center for Life Sciences, Beijing, China.
³⁴ European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
³⁵ Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
³⁶ Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
³⁷ Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, England.
³⁸ Department of Renal Medicine, St George Hospital and University of New South Wales, Sydney, New South Wales, Australia.
³⁹ Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴⁰ Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
⁴¹ UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, United Kingdom and Population Health Sciences, University of Bristol, Bristol, United Kingdom.
⁴² Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, United Kingdom.

PMID: 33323461
PMCID: PMC7792657
DOI: 10.2215/CJN.09070620

Abstract

Background and objectives: People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality.

Design, setting, participants, & measurements: The Global Kidney Health Atlas is an ongoing initiative of the International Society of Nephrology that aims to monitor and evaluate the status of global kidney care worldwide. This study reports on findings from the 2018 Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of conservative kidney management.

Results: Respondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery.

Conclusions: Overall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.

Keywords: capacity; conservative kidney management; global health; kidney failure; survey.

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References

1. Anand S, Kurella Tamura M, Chertow GM: The elderly patients on hemodialysis. Minerva Urol Nefrol 62: 87–101, 2010 - PMC - PubMed
1. Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, Murtagh FE, Naicker S, Germain MJ, O’Donoghue DJ, Morton RL, Obrador GT; Kidney Disease Improving Global Outcomes : Executive summary of the Kidney Disease Improving Global Outcomes controversies conference on supportive care in chronic kidney disease: Developing a roadmap to improving quality care. Available at: https://kdigo.org/. Kidney Int 88: 447–459, 2015. - PubMed
1. Brown MA, Crail SM, Masterson R, Foote C, Robins J, Katz I, Josland E, Brennan F, Stallworthy EJ, Siva B, Miller C, Urban AK, Sajiv C, Glavish RN, May S, Langham R, Walker R, Fassett RG, Morton RL, Stewart C, Phipps L, Healy H, Berquier I: ANZSN renal supportive care 2013: Opinion pieces [corrected] [published correction appears in Nephrology (Carlton) 19: 175, 2014]. Nephrology (Carlton) 18: 401–454, 2013 - PubMed
1. Davison SN, Tupala B, Wasylynuk BA, Siu V, Sinnarajah A, Triscott J: Recommendations for the care of patients receiving conservative kidney management: Focus on management of CKD and symptoms. Clin J Am Soc Nephrol 14: 626–634, 2019 - PMC - PubMed
1. Ladin K, Pandya R, Kannam A, Loke R, Oskoui T, Perrone RD, Meyer KB, Weiner DE, Wong JB: Discussing conservative management with older patients with CKD: An interview study of nephrologists. Am J Kidney Dis 71: 627–635, 2018 - PMC - PubMed

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Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

Affiliations

Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials