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

Abstract

Delivery of care for kidney failure (KF) globally has a significant disparity; even in some countries, it means end of life for the person. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) tries to address gaps in KF care and standardize global nephrology care. From the third iteration of the ISN-GKHA, we present data for countries in the ISN Eastern and Central Europe region. The median prevalences of chronic kidney disease (12.8%) and treated KF (873.5 pmp) were higher than the global rates, respectively. Hemodialysis was the most preferred modality for KF in adults, whereas kidney replacement therapy was more balanced in children. Although most of the countries in the region had lower-middle-income and upper-middle-income levels, health expenditures for kidney health care were almost generally covered publicly. Nephrologists were responsible for the medical kidney care of people with KF in all countries. There was adequate infrastructure to provide all kinds of treatment for kidney care in the region. Regional characteristics such as high levels of obesity, smoking, and Balkan nephropathy as an endemic disease coupled with a shortage of workforce and finance continued to affect kidney care in the region negatively. By making organizational and legislative arrangements, partnerships with national authorities and societies may accelerate the improvement of kidney health care in the region.

Keywords: Eastern and Central Europe; Global Kidney Health Atlas; epidemiology; kidney failure; kidney replacement therapy.

Figure 1

Countries of the International Society of Nephrology Eastern and Central Europe region. NIS, Newly Independent States.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT) globally and in the ISN Eastern and Central Europe region. Values represent an absolute number of countries in each category expressed as a percentage of a total number of countries. AKI, acute kidney injury; HD, hemodialysis; N/A, not applicable; NGOs, nongovernmental organizations; PD, peritoneal dialysis.

Figure 3

Country-level scorecard for kidney care in the International Society of Nephrology Eastern and Central Europe region, 2019 and 2023. Funding for medications refers to 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; KRT, kidney replacement therapy; N/A, not provided or no response; PD, peritoneal dialysis; PMP, per million population.

Figure 4

Availability of choice in kidney replacement therapy or conservative kidney management (CKM) for people living with kidney failure in the International Society of Nephrology Eastern and Central Europe region. Values represent an absolute number of countries in each category expressed as a percentage of a total number of countries. HD, hemodialysis; Kt/V, measure of dialysis adequacy; N/A, not applicable; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 5

Quality indicators monitored and reported in the International Society of Nephrology Eastern and Central Europe region. HBV, hepatitis B virus; HIV, human immunodeficiency virus.