International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean

Abstract

The International Society of Nephrology established the Global Kidney Health Atlas project to define the global capacity for kidney replacement therapy and conservative kidney care, and this second iteration was to describe the availability, accessibility, quality, and affordability of kidney failure (KF) care worldwide. This report presents results for the International Society of Nephrology North America and the Caribbean region. Relative to other regions, the North America and Caribbean region had better infrastructure and funding for health care and more health care workers relative to the population. Various essential medicines were also more available and accessible. There was substantial variation in the prevalence of treated KF in the region, ranging from 137.4 per million population (pmp) in Jamaica to 2196 pmp in the United States. A mix of public and private funding systems cover costs for nondialysis chronic kidney disease care in 60% of countries and for dialysis in 70% of countries. Although the median number of nephrologists is 18.1 (interquartile range, 15.3-29.5) pmp, which is approximately twice the global median of 9.9 (interquartile range, 1.2-22.7) pmp, some countries reported shortages of other health care workers. Dialysis was available in all countries, but peritoneal dialysis was underutilized and unavailable in Barbados, Cayman Islands, and Turks and Caicos. Kidney transplantation was primarily available in Canada and the United States. Economic factors were the major barriers to optimal KF care in the Caribbean countries, and few countries in the region have chronic kidney disease-specific national health care policies. To address regional gaps in KF care delivery, efforts should be directed toward augmenting the workforce, improving the monitoring and reporting of kidney replacement therapy indicators, and implementing noncommunicable disease and chronic kidney disease-specific policies in all countries.

Keywords: chronic kidney disease; dialysis; funding; kidney failure; kidney registries; workforce.

Figure 1

Countries in the International Society of Nephrology (ISN) North America and the Caribbean region that participated in the ISN Global Kidney Health Atlas survey.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT) care in the International Society of Nephrology North America and the Caribbean region. Absolute number of countries in each category expressed as a percentage of total number of countries. HD, hemodialysis; N/A, not available; NGOs, nongovernmental organizations; PD, peritoneal dialysis.

Figure 3

Availability of choice in kidney replacement therapy or conservative kidney management for patients with kidney failure. Values represent absolute number of countries in each category, expressed as a percentage of total number of countries. HD, hemodialysis; Kt/V, measure of dialysis adequacy; N/A, not provided; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 4

Accessibility of kidney replacement therapy for patients with kidney failure (KF) in the International Society of Nephrology North America and the Caribbean region. Values represent absolute number of countries in each category, expressed as a percentage of total number of countries. N/A, not available; PD, peritoneal dialysis.

Figure 5

Country-level scorecard for registries, national policies, advocacy, and barriers to optimal kidney failure (KF) care in the International Society of Nephrology North America and the Caribbean region. AKI, acute kidney injury; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; FHx, family history; HTN, hypertension; KRT, kidney replacement therapy.