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

Abstract

The highest financial and symptom burdens and the lowest health-related quality-of-life scores are seen in people with kidney failure. A total of 11 countries in the International Society of Nephrology (ISN) Middle East region responded to the ISN-Global Kidney Health Atlas. The prevalence of chronic kidney disease (CKD) in the region ranged from 4.9% in Yemen to 12.2% in Lebanon, whereas prevalence of kidney failure treated with dialysis or transplantation ranged from 152 per million population (pmp) in the United Arab Emirates to 869 pmp in Kuwait. Overall, the incidence of kidney transplantation was highest in Saudi Arabia (20.2 pmp) and was lowest in Oman (2.2 pmp). Chronic hemodialysis (HD) and peritoneal dialysis (PD) services were available in all countries, whereas kidney transplantation was available in most countries of the region. Public government funding that makes acute dialysis, chronic HD, chronic PD, and kidney transplantation medications free at the point of delivery was available in 54.5%, 72.7%, 54.5%, and 54.5% of countries, respectively. Conservative kidney management was available in 45% of countries. Only Oman had a CKD registry; 7 countries (64%) had dialysis registries, and 8 (73%) had kidney transplantation registries. The ISN Middle East region has a high burden of kidney disease and multiple challenges to overcome. Prevention and detection of kidney disease can be improved by the design of tailored guidelines, allocation of additional resources, improvement of early detection at all levels of care, and implementation of sustainable health information systems.

Keywords: Global Kidney Health Atlas; ISN; epidemiology; kidney failure; kidney replacement therapy; the Middle East.

Figure 1

Countries of the International Society of Nephrology Middle East region. NIS, newly independent states.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT) care, globally and in the International Society of Nephrology Middle East region. Values represent absolute number of countries in each category expressed as a percentage of the total number of countries. AKI, acute kidney injury; HD, hemodialysis; KRT, kidney replacement therapy; N/A, not available; NGOs, nongovernment organizations; PD, peritoneal dialysis.

Figure 3

Availability of choice in kidney replacement therapy or conservative kidney management (CKM) for people with kidney failure in the International Society of Nephrology Middle East region. Values represent absolute number of countries in each category expressed as a percentage of the total number of countries. HD, hemodialysis; Kt/V, (dialyzer clearance of urea x dialysis time)/volume; N/A, not available; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 4

Accessibility of kidney replacement therapy (KRT) for people with kidney failure (KF), globally and in the International Society of Nephrology Middle East region. Values represent absolute number of countries in each category expressed as a percentage of the total number of countries. N/A, not applicable; PD, peritoneal dialysis.

Figure 5

Country-level scorecard showing availability of kidney replacement therapy (KRT), funding of medications, registries, and advocacy groups of countries in the International Society of Nephrology Middle East region, 2019 and 2023. Funding for medications refers to medications being 100% publicly funded by the government (free at the point of delivery). AKI, acute kidney injury; CKD, chronic kidney disease; CKM, conservative kidney management; HD, hemodialysis; KF, kidney failure; KT, kidney transplantation; N/A, not available; PD, peritoneal dialysis; PMP, per million population; Rep., Republic.