Capacity for the management of kidney failure in the International Society of Nephrology Oceania and South East Asia (OSEA) region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Abstract

The International Society of Nephrology (ISN) region of Oceania and South East Asia (OSEA) is a mix of high- and low-income countries, with diversity in population demographics and densities. Three iterations of the ISN-Global Kidney Health Atlas (GKHA) have been conducted, aiming to deliver in-depth assessments of global kidney care across the spectrum from early detection of CKD to treatment of kidney failure. This paper reports the findings of the latest ISN-GKHA in relation to kidney-care capacity in the OSEA region. Among the 30 countries and territories in OSEA, 19 (63%) participated in the ISN-GKHA, representing over 97% of the region's population. The overall prevalence of treated kidney failure in the OSEA region was 1203 per million population (pmp), 45% higher than the global median of 823 pmp. In contrast, kidney replacement therapy (KRT) in the OSEA region was less available than the global median (chronic hemodialysis, 89% OSEA region vs. 98% globally; peritoneal dialysis, 72% vs. 79%; kidney transplantation, 61% vs. 70%). Only 56% of countries could provide access to dialysis to at least half of people with incident kidney failure, lower than the global median of 74% of countries with available dialysis services. Inequalities in access to KRT were present across the OSEA region, with widespread availability and low out-of-pocket costs in high-income countries and limited availability, often coupled with large out-of-pocket costs, in middle- and low-income countries. Workforce limitations were observed across the OSEA region, especially in lower-middle-income countries. Extensive collaborative work within the OSEA region and globally will help close the noted gaps in kidney-care provision.

Keywords: Global Kidney Health Atlas; ISN; Oceania and South East Asia; epidemiology; kidney failure; kidney replacement therapy.

Figure 1

Countries and territories of the International Society of Nephrology Oceania and South East Asia (ISN OSEA) region. Fed. Sts., federated states.

Figure 2

Country-level scorecard for kidney replacement therapy (KRT), conservative kidney management (CKM), funding for medications, registry, and advocacy group in the International Society of Nephrology Oceania and South East Asia (ISN OSEA) region in 2019 and 2023. Funding for medications means that the medications are 100% publicly funded by the government (free at the point of delivery). AKI, acute kidney injury; CKD, chronic kidney disease; HD, hemodialysis; KF, kidney failure; KT, kidney transplantation; PD, peritoneal dialysis; PMP, per million population; N/A, not available or not provided; PDR, People’s Democratic Republic.

Figure 3

Availability of (a) hemodialysis and (b) peritoneal dialysis in the International Society of Nephrology Oceania and South East Asia (ISN OSEA) region, compared to their global availability. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. N/A, dialysis not provided.

Figure 4

Availability of kidney replacement therapy centers in the International Society of Nephrology Oceania and South East Asia (ISN OSEA) region: (a) hemodialysis centers; (b) peritoneal dialysis centers; and (c) transplantation centers. pmp, per million population.