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

Abstract

The International Society of Nephrology Global Kidney Health Atlas charts the availability and capacity of kidney care globally. In the North America and the Caribbean region, the Atlas can identify opportunities for kidney care improvement, particularly in Caribbean countries where structures for systematic data collection are lacking. In this third iteration, respondents from 12 of 18 countries from the region reported a 2-fold higher than global median prevalence of dialysis and transplantation, and a 3-fold higher than global median prevalence of dialysis centers. The peritoneal dialysis prevalence was lower than the global median, and transplantation data were missing from 6 of the 10 Caribbean countries. Government-funded payments predominated for dialysis modalities, with greater heterogeneity in transplantation payor mix. Services for chronic kidney disease, such as monitoring of anemia and blood pressure, and diagnostic capability relying on serum creatinine and urinalyses were universally available. Notable exceptions in Caribbean countries included non-calcium-based phosphate binders and kidney biopsy services. Personnel shortages were reported across the region. Kidney failure was identified as a governmental priority more commonly than was chronic kidney disease or acute kidney injury. In this generally affluent region, patients have better access to kidney replacement therapy and chronic kidney disease-related services than in much of the world. Yet clear heterogeneity exists, especially among the Caribbean countries struggling with dialysis and personnel capacity. Important steps to improve kidney care in the region include increased emphasis on preventive care, a focus on home-based modalities and transplantation, and solutions to train and retain specialized allied health professionals.

Keywords: chronic kidney disease; dialysis nurses; hemodialysis; kidney care funding; kidney transplantation; peritoneal dialysis.

Figure 1

Countries in the International Society of Nephrology North America and the Caribbean region, with quartiles of nephrologist prevalence in each country shown.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy care, globally and in the International Society of Nephrology North America and the Caribbean (NAC) region. Values represent absolute number of countries in each category expressed as a percentage of total number of countries. gov., government; HD, hemodialysis; N/A: not available; PD, peritoneal dialysis.

Figure 3

Country-level scorecard showing availability of kidney replacement therapy (KRT), funding of medications, registry, and advocacy groups in the International Society of Nephrology North America and the Caribbean region, 2019 and 2023. Funding for medications refers to 100% public funding 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 available; 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 North America and the Caribbean region. Values represent absolute number of countries in each category expressed as a percentage of total number of countries. HD, hemodialysis; Kt/V, clearance time per volume; N/A, not available; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 5

Availability of services for kidney care in the International Society of Nephrology North America and the Caribbean region. Values represent absolute number of countries in each category expressed as a percentage of total number of countries. BP, blood pressure.