International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Oceania and South East Asia

Abstract

Oceania and South East Asia (OSEA) is a socioeconomically, culturally, and ethnically diverse region facing a rising epidemic of noncommunicable diseases, including chronic kidney disease (CKD). The second iteration of the International Society of Nephrology Global Kidney Health Atlas aimed to provide a comprehensive evaluation of kidney care in OSEA. Of the 30 countries/territories in OSEA, 15 participated in the survey, representing 98.5% of the region's population. The median prevalence of treated kidney failure in OSEA was 1352 per million population (interquartile range, 966-1673 per million population), higher than the global median of 787 per million population. Although the general availability, access, and quality of kidney replacement therapy (i.e., dialysis and transplantation) was high in OSEA, inequalities in accessibility and affordability of kidney replacement therapy across the region resulted in variability between countries. According to the survey results, in a third of the participating countries (mostly lower-income countries), less than half the patients with kidney failure were able to access dialysis, whereas it was readily available to all with minimal out-of-pocket costs in high-income countries; similar variability in access to transplantation was also recorded. Limitations in workforce and resources vary across the region and were disproportionately worse in lower-income countries. There was little advocacy for kidney disease, moderate use of registries, restricted CKD detection programs, and limited availability of routine CKD testing in some high-risk groups across the region. International collaborations, as seen in OSEA, are important initiatives to help close the gaps in CKD care provision across the region and should continue receiving support from the global nephrology community.

Keywords: Oceania and South East Asia; dialysis; end-stage kidney disease; global health care; health care delivery; health policy; nephrology; surveys and questionnaires.

Figure 1

Countries and territory participating in the International Society of Nephrology (ISN) Global Kidney Health Atlas survey in the ISN Oceania and South East Asia region.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT) care reported by the countries and territory participating in the International Society of Nephrology Global Kidney Health Atlas survey. Values represent absolute number of countries in each category, expressed as a percentage of total number of participating countries. In Oceania and South East Asia (OSEA), when peritoneal dialysis/transplantation is not available, funding structure is listed as N/A. HD, hemodialysis; NGOs, nongovernmental organizations; PD, peritoneal dialysis.

Figure 3

Availability of choice in kidney replacement therapy or conservative care for patients with kidney failure reported by the 15 Oceania and South East Asia countries and territory participating in the International Society of Nephrology Global Kidney Health Atlas survey. In some countries, kidney transplantation is not available locally, but some services related to transplantation are available. 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), reported by the countries and territory participating in the International Society of Nephrology Global Kidney Health Atlas survey. In some Oceania and South East Asia (OSEA) countries, kidney transplantation is not available locally, but some services related to transplantation are available. N/A, not provided; PD, peritoneal dialysis.

Figure 5

Country-level scorecard for registries, national policies, advocacy, and barriers to optimal kidney care in the International Society of Nephrology Oceania and South East Asia region. AKI, acute kidney injury; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; FHx, family history; HTN, hypertension; KF, kidney failure; KRT, kidney replacement therapy; PDR, People’s Democratic Republic.