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. 2024 May 8;25(1):159.
doi: 10.1186/s12882-024-03593-z.

Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas

Anukul Ghimire  1 , Samveg Shah  2 , Utkarsh Chauhan  3 , Kwaifa Salihu Ibrahim  4   5 , Kailash Jindal  3 , Rumeyza Kazancioglu  6 , Valerie A Luyckx  7   8   9 , Jennifer M MacRae  10 , Timothy O Olanrewaju  11   12 , Robert R Quinn  13 , Pietro Ravani  10 , Nikhil Shah  3 , Stephanie Thompson  3 , Somkanya Tungsanga  3   14 , Tushar Vachharanjani  15 , Silvia Arruebo  16 , Fergus J Caskey  17 , Sandrine Damster  16 , Jo-Ann Donner  16 , Vivekanand Jha  18   19   20 , Adeera Levin  21 , Charu Malik  16 , Masaomi Nangaku  22 , Syed Saad  3 , Marcello Tonelli  23   24 , Feng Ye  3 , Ikechi G Okpechi  3   25   26 , Aminu K Bello #  3 , David W Johnson #  27   28   29   30
Affiliations

Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas

Anukul Ghimire et al. BMC Nephrol. .

Abstract

Background: There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions.

Methods: Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN.

Results: Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters).

Conclusions: High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.

Keywords: Arteriovenous fistulas; Central venous catheters; Dialysis; Global kidney Health Atlas; International Society of Nephrology; Kidney failure.

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Conflict of interest statement

All authors have completed an ICMJE form. RK reports personal fees from Baxter healthcare, outside the submitted work. VAL reports royalties from Elsevier, consulting fees from the World Health Organization, travel support from the European Renal Association and International Society of Nephrology, and leadership role in Advocacy Working Group of the International Society of Nephrology, outside the submitted work. RRQ reports honoraria from Baxter Healthcare Corporation and the patent Dialysis Information Management System, Canada, outside the submitted work. NS reports personal fees from Baxter, grants and personal fees from Amgen, outside the submitted work. ST reports Fellowship grants from the International Society of Nephrology-Salmasi Family and the Kidney Foundation of Thailand, outside the submitted work. SA reports personal fees from The International Society of Nephrology, outside the submitted work. SD reports personal fees from The International Society of Nephrology, outside the submitted work. JD reports personal fees from The International Society of Nephrology, outside the submitted work. VJ reports personal fees from GSK, Astra Zeneca, Baxter Healthcare, Visterra, Biocryst, Chinook, Vera, and Bayer, paid to his institution, outside the submitted work. CM reports personal fees from The International Society of Nephrology, outside the submitted work. MN reports grants and personal fees from KyowaKirin, Boehringer Ingelheim, Chugai, Daiichi Sankyo, Torii, JT, Mitsubishi Tanabe, grants from Takeda and Bayer, and personal fees from Astellas, Akebia, AstraZeneca, and GSK, outside the submitted work. AKB reports other (consultancy and honoraria) from AMGEN Incorporated and Otsuka, other (consultancy) from Bayer and GSK, and grants from Canadian Institute of Health Research and Heart and Stroke Foundation of Canada, outside the submitted work; He is also Associate Editor of the Canadian Journal of Kidney Health and Disease and Co-chair of the ISN-Global Kidney Health Atlas. DWJ reports 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 Boehringer Ingelheim & Lilly, and travel sponsorships from Ono and Amgen, outside the submitted work. He is also a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant, outside the submitted work. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Geographic heatmap for the dominant approach to dialysis initiation by country. Data was generated from survey responses highlighting the utilization of various techniques. As responses were reported in ranges [0-10, 11-50, 50-74, 75%+], multiple countries were considered "co-dominant" if there were an equal reported range for two approaches to initiate dialysis. AV, arteriovenous; AVF, arteriovenous fistula; AVG, arteriovenous graft
Fig. 2
Fig. 2
Geographic heatmaps demonstrating international variation in the method of dialysis initiation. (A) Proportion of patients routinely starting dialysis with AV fistula or graft. (B) Proportion of patients routinely starting with a tunneled dialysis catheter. Answers range from 0% (None), 1–10% (Few), 11–50% (Some), 51–75% (Most), and > 75% (Almost all). AV, arteriovenous
Fig. 3
Fig. 3
Geographic heatmap demonstrating international variation in the proportion of patients routinely starting dialysis with a temporary dialysis catheter. Answers range from 0% (None), 1–10% (Few), 11–50% (Some), 51–75% (Most), and > 75% (Almost all)
Fig. 4
Fig. 4
Healthcare systems coverage for surgical services for Kidney Replacement Therapy. Funding models for the creation of central venous catheters are shown as bar plot segments representing a fraction of countries in each International Society of Nephrology region (A) and in each category of World Bank Income Group (C). Funding models for the creation of arteriovenous fistulas and grafts are shown as bar plot segments representing a fraction of countries in each International Society of Nephrology region (B) and in each category of World Bank Income Group (D). NGO, non-governmental organization; NIS, Newly Independent States; OSEA, Oceania and South East Asia
See this image and copyright information in PMC

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