National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas

Brendon L Neuen^{1

2}, Aminu K Bello³, Adeera Levin⁴, Meaghan Lunney⁵, Mohamed A Osman³, Feng Ye³, Gloria E Ashuntantang⁶, Ezequiel Bellorin-Font⁷, Mohammed Benghanem Gharbi⁸, Sara Davison³, Mohammad Ghnaimat⁹, Paul Harden¹⁰, Vivekanand Jha^{11

12

13}, Kamyar Kalantar-Zadeh¹⁴, Peter G Kerr¹⁵, Scott Klarenbach³, Csaba P Kovesdy¹⁶, Valerie Luyckx^{17

18}, Shahrzad Ossareh¹⁹, Jeffrey Perl^{20

21}, Harun Ur Rashid²², Eric Rondeau^{23

24}, Emily J See^{25

26}, Syed Saad³, Laura Sola²⁷, Irma Tchokhonelidze²⁸, Vladimir Tesar²⁹, Kriang Tungsanga³⁰, Rumeyza Turan Kazancioglu³¹, Angela Yee-Moon Wang³², Chih-Wei Yang³³, Alexander Zemchenkov^{34

35}, Ming-Hui Zhao^{36

37

38

39}, Kitty J Jager⁴⁰, Fergus J Caskey^{41

42}, Vlado Perkovic¹, Kailash K Jindal³, Ikechi G Okpechi^{3

43

44}, Marcello Tonelli^{45

46}, John Feehally⁴⁷, David C Harris⁴⁸, David W Johnson^{49

50

51}

Affiliations

¹ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
² Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
³ Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.
⁴ Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Calgary, Canada.
⁶ Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon.
⁷ Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, United States of America.
⁸ Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco.
⁹ Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan.
¹⁰ Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
¹¹ George Institute for Global Health India, New Delhi, India.
¹² School of Public Health, Imperial College, London, United Kingdom.
¹³ Manipal Academy of Higher Education, Manipal, India.
¹⁴ Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, United States of America.
¹⁵ Department of Medicine, Monash University, Melbourne, Australia.
¹⁶ University of Tennessee Health Science Center, Memphis, Tennessee, United States of America.
¹⁷ Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
¹⁸ Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
¹⁹ Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
²⁰ Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
²¹ Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada.
²² Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh.
²³ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.
²⁴ Sorbonne Université, Paris, France.
²⁵ Department of Intensive Care, Austin Health, Melbourne, Australia.
²⁶ School of Medicine, University of Melbourne, Melbourne, Australia.
²⁷ Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay.
²⁸ Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
²⁹ Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic.
³⁰ Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
³¹ Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey.
³² Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
³³ Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
³⁴ Department of Internal Disease and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.
³⁵ Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.
³⁶ Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
³⁷ Key Lab of Renal Disease, Ministry of Health of China, Beijing, China.
³⁸ Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China; Beijing, China.
³⁹ Peking-Tsinghua Center for Life Sciences, Beijing, China.
⁴⁰ ERA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁴¹ Population Health Sciences, University of Bristol, Bristol, United Kingdom.
⁴² The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
⁴³ Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
⁴⁴ Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
⁴⁵ Department of Medicine, University of Calgary, Calgary, Canada.
⁴⁶ Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Canada.
⁴⁷ University of Leicester, Leicester, United Kingdom.
⁴⁸ Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia.
⁴⁹ Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.
⁵⁰ Translational Research Institute, Brisbane, Australia.
⁵¹ Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia.

PMID: 36963092
PMCID: PMC10021302
DOI: 10.1371/journal.pgph.0001467

National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas

Brendon L Neuen et al. PLOS Glob Public Health. 2023.

. 2023 Feb 1;3(2):e0001467.

doi: 10.1371/journal.pgph.0001467. eCollection 2023.

Authors

Affiliations

¹ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
² Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
³ Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.
⁴ Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Calgary, Canada.
⁶ Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon.
⁷ Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, United States of America.
⁸ Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco.
⁹ Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan.
¹⁰ Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
¹¹ George Institute for Global Health India, New Delhi, India.
¹² School of Public Health, Imperial College, London, United Kingdom.
¹³ Manipal Academy of Higher Education, Manipal, India.
¹⁴ Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, United States of America.
¹⁵ Department of Medicine, Monash University, Melbourne, Australia.
¹⁶ University of Tennessee Health Science Center, Memphis, Tennessee, United States of America.
¹⁷ Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
¹⁸ Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
¹⁹ Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
²⁰ Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
²¹ Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada.
²² Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh.
²³ Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.
²⁴ Sorbonne Université, Paris, France.
²⁵ Department of Intensive Care, Austin Health, Melbourne, Australia.
²⁶ School of Medicine, University of Melbourne, Melbourne, Australia.
²⁷ Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay.
²⁸ Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
²⁹ Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic.
³⁰ Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
³¹ Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey.
³² Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
³³ Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
³⁴ Department of Internal Disease and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.
³⁵ Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.
³⁶ Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
³⁷ Key Lab of Renal Disease, Ministry of Health of China, Beijing, China.
³⁸ Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China; Beijing, China.
³⁹ Peking-Tsinghua Center for Life Sciences, Beijing, China.
⁴⁰ ERA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁴¹ Population Health Sciences, University of Bristol, Bristol, United Kingdom.
⁴² The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
⁴³ Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
⁴⁴ Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
⁴⁵ Department of Medicine, University of Calgary, Calgary, Canada.
⁴⁶ Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Canada.
⁴⁷ University of Leicester, Leicester, United Kingdom.
⁴⁸ Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia.
⁴⁹ Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.
⁵⁰ Translational Research Institute, Brisbane, Australia.
⁵¹ Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia.

PMID: 36963092
PMCID: PMC10021302
DOI: 10.1371/journal.pgph.0001467

Abstract

National strategies for addressing chronic kidney disease (CKD) are crucial to improving kidney health. We sought to describe country-level variations in non-communicable disease (NCD) strategies and CKD-specific policies across different regions and income levels worldwide. The International Society of Nephrology Global Kidney Health Atlas (GKHA) was a multinational cross-sectional survey conducted between July and October 2018. Responses from key opinion leaders in each country regarding national NCD strategies, the presence and scope of CKD-specific policies, and government recognition of CKD as a health priority were described overall and according to region and income level. 160 countries participated in the GKHA survey, comprising 97.8% of the world's population. Seventy-four (47%) countries had an established national NCD strategy, and 53 (34%) countries reported the existence of CKD-specific policies, with substantial variation across regions and income levels. Where CKD-specific policies existed, non-dialysis CKD care was variably addressed. 79 (51%) countries identified government recognition of CKD as a health priority. Low- and low-middle income countries were less likely to have strategies and policies for addressing CKD and have governments which recognise it as a health priority. The existence of CKD-specific policies, and a national NCD strategy more broadly, varied substantially across different regions around the world but was overall suboptimal, with major discrepancies between the burden of CKD in many countries and governmental recognition of CKD as a health priority. Greater recognition of CKD within national health policy is critical to improving kidney healthcare globally.

Copyright: © 2023 Neuen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Conflict of interest statement

Outside the submitted work, BLN has received fees for advisory boards, scientific presentations, steering committee roles and travel support from AstraZeneca, Bayer, Boehringer and Ingelheim, and Janssen with all honoraria paid to his institution; AL and serves as a scientific advisor to Boehringer Ingelheim, AstraZeneca, and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); is on the data safety and monitoring board for the NIDDK, Kidney Precision Medicine, University of Washington Kidney Research Institute Scientific Advisory Committee; is funded by the Canadian Institute of Health Research and Kidney Foundation of Canada; PH reports grants from Chiesi Pharmaceuticals; VJ has research grants from Baxter, GSK and reports Consultancy and Advisory Board honoraria from Baxter Healthcare, and AstraZeneca; KK-Z has received honoraria and/or support from Abbott, Abbvie, ACI Clinical (Cara Therapeutics), Akebia, Alexion, Amgen, Ardelyx, ASN (American Society of Nephrology), Astra-Zeneca, Aveo, BBraun, Chugai, Cytokinetics, Daiichi, DaVita, Fresenius, Genentech, GSK, Haymarket Media, Hofstra Medical School, IFKF (International Federation of Kidney Foundations), ISH (International Society of Hemodialysis), International Society of Renal Nutrition & Metabolism (ISRNM), JSDT (Japanese Society of Dialysis Therapy), Hospira, Kabi, Keryx, Kissei, Novartis, Novo-Nordisk, OPKO, NIH (National Institutes of Health), NKF (National Kidney Foundations), Pfizer, Regulus, Relypsa, Resverlogix, Dr Schaer, Sandoz, Sanofi, Shire, VA (Veterans’ Affairs), Takeda, Vifor, UpToDate, ZS-Pharma; PGK reports conference attendance support from Amgen Australia and honorarium from Bayer Australia; SK is Director of the Real World Evidence Consortium that conducts investigator initiated industry funded projects (Allergan, Purdue, GSK, CSL, Lundbeck, NovoNordisk, Jansen, Bayer); CPK has received consulting fees from Abbott, Akebia, Astra-Zeneca, Bayer, Cara Therapeutics, CSL Behring, Rockwell and Vifor; JP reports grants and personal fees from Baxter Healthcare, Fresenius Medical Care, and Davita Healthcare partner; RTK reports personal fees from Baxter; AY-MW reports grants from Sanofi and Otsuka; MHZ has been a consultant or advisory committee member for GSK, AstraZeneca, Roche, and Bayer; KJJ reports personal fees from Fresenius Medical Care; VP has received fees for advisory boards, steering committee roles, or scientific presentations from AbbVie, Astellas, AstraZeneca, Bayer, Baxter, BMS, Boehringer Ingelheim, Dimerix, Durect, Eli Lilly, Gilead, GSK, Janssen, Merck, Mitsubishi Tanabe, Mundipharma, Novartis, Novo Nordisk, Pfizer, Pharmalink, Relypsa, Retrophin, Sanofi, Servier, Tricida, and Vifor. MT reports grants from the Canadian Institutes for Health Research during conduct of the study; DWJ has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer, and AWAK, speaker’s honoraria from ONO and BI & Lilly, and travel sponsorships from Ono and Amgen. He is a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant.

Figures

**Fig 1. Kidney conditions covered by CKD-specific and general NCD strategies.**

**Fig 2. Government recognition as a priority (A) and availability of an advocacy group (B) for AKI, CKD, and kidney failure treatment and prevention.**

See this image and copyright information in PMC

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National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas

Affiliations

National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources