Global Policy and Advocacy Initiatives for Improving Kidney Care: Report from the 2023 International Society of Nephrology Global Kidney Health Atlas

Abstract

Key Points:

1. Inclusion and prioritization of CKD and kidney failure within national health strategies are generally lacking.

2. Countries with CKD-specific strategies tend to include and fund a broader spectrum of kidney disease populations and kidney care.

3. Greater global and national prioritization of kidney health are required to reduce global inequities in access to kidney care.

Background: National strategies to address CKD are crucial to support kidney health. Lack of political support in the form of policy decisions and funding leads to fragmentation of kidney care and catastrophic health expenditure. This study used data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas to obtain a global overview of the existence and reach of national strategies for kidney care.

Methods: We leveraged data from an international survey of stakeholders (clinicians, policymakers, and patient advocates) conducted by the International Society of Nephrology between July and September 2022. Data were extracted on existence and scope of national noncommunicable disease (NCD) and/or CKD-specific strategies and policies, as well as recognition of kidney disease as a national health priority through participant perception and existence of CKD advocacy groups.

Results: Overall, stakeholders from 167 countries responded to the survey, representing 97.4% of the global population. National strategies for NCDs were reported by 56% of countries. In 29% of countries, CKD was addressed within an NCD strategy, whereas 25% of countries reported CKD-specific strategies. Countries with CKD-specific strategies were more likely to address all CKD populations (non–dialysis-dependent CKD, chronic dialysis, and kidney transplantation) compared with those with NCD strategies only (51.2% versus 19%). Of the 54% of countries with any CKD strategy, 89% reported public funding of the full spectrum of CKD care compared with 64% of those with no CKD strategy. Kidney failure, CKD, and AKI were reported to be recognized as national health priorities by 63%, 48%, and 19% of countries, respectively.

Conclusions: The inclusion of CKD and kidney failure within national health strategies is frequently lacking. Countries with CKD-specific policies tend to include a broader spectrum of kidney disease populations and to fund kidney care more than those with CKD policies integrated within NCD strategies. Greater global and national prioritization of kidney health are required to reduce global inequities in access to kidney care.

Graphical abstract

Figure 1

Type of national CKD strategy and population covered. NCD, noncommunicable disease.

Figure 2

Association between existence and type of CKD strategy and public funding of CKD care.

Figure 3

Association between national recognition of CKD and existence of advocacy groups.

Figure 4

Association between national recognition of AKI and existence of advocacy groups.

Figure 5

Association between national recognition of KF and existence of advocacy groups. KF, kidney failure.

Figure 6

Summary figure of the policy implementation process to support kidney care programs.