Global Kidney Health Atlas: Why We Need It and How It May Affect CKD Worldwide

Session: Global Challenges of CKD

Sub-session: Global Kidney Health Atlas: Why We Need It and How It May Affect CKD Worldwide

Presenter: David W. Johnson DrMed, MBBS, PhD, FASN

David W. JohnsonDavid W. Johnson, MBBS, led the session of the global challenges of CKD with his presentation on the Global Kidney Health Atlas (GKHA), why a report like this is needed and how it may impact CKD worldwide.

The GKHA gathers “data [from all over the globe] to determine the status of existing resources, structures and organizations available to patients with CKD and AKI”.

The International Society of Nephrology provides updates of this atlas to better understand, compare and monitor how different countries around the world detect, treat, monitor and advocate for people with kidney disease (AKI or CKD).

A look back on Global Kidney Health Atlas (GKHA) 2017

First, Dr. Johnson revealed the main results from GKHA 2017, with data from 125 countries (93 percent of global coverage):

Workforce shortages: Nephrologists (74%); Others (60-86%)

Poor CKD detection: Kidney check (50%); Poor awareness (68%)

Low public funding kidney care: (35% UHC)

Low kidney disease priority recognition: (36%)

Few national kidney strategies: CKD (44%); AKI (16%)

Few kidney disease registries: CKD (8%); AKI (7%); Dialysis (64%); Transplant (58%)

Sparse kidney advocacy: CKD (42%); AKI (19%)

Deficient research capacity: No capacity (31%)

Then, Dr. Johnson revealed the GKHA 2019 main results from 160 countries (98.6 percent global coverage) which was released 2 weeks ago:

Workforce shortages: >80% LMIC; nephrologist LIC 1% of HIC

Poor dialysis accessibility: ≥50% in 72% (5% LIC); lowest in Africa, South Asia, OSEA PD underutilized

Poor transplant accessibility: ≥50% in 29% (0% LIC); ≤10% in majority LMIC; lowest in Africa/Asia/OSEA

Suboptimal conservative care: available in 81%; easily accessible in 41%

Poor affordability: fees 57%; OOP >75% in most LIC

Few KRT registries: 1/3 lack registry: LIC Dx 18%, Tx 0%

Uncertain quality: most LIC do not measure or report quality indicators

Poor kidney care: 61% lack CKD-specific care (100% LIC)

The Importance of the GKHA

The GKHA provides:

A platform for championing the cause of CKD using the identified gaps modeled on UHC domains
A foundation for a worldwide CKD care surveillance network and holds countries accountable for what progress, if any, is happening in closing the gap in CKD care
An evaluation of the current state of kidney care, how it is organized and structured globally, all of which are crucial for better health policy

Key Strategies of the GKHD include:

Early detection and prevention programs for CKD
Address and improve nephrology workforce shortages
Establish renal registries for reliable information on CKD
Establish minimum care quality standards for CKD
Reduce financial barriers
Provide affordable dialysis options

The GKHA demonstrates “significant inter- and intra-regional variability in the current capacity for kidney care across the globe.” This project has identified critical gaps in services, facilities and workforce in many of the countries included.

Looking to future improvements, the GKHA offers the opportunity for engaging key government and non-government stakeholders in supporting countries who work towards improving the quality of care in patients with CKD, scorecard process for countries, and devises policy implications for CKD in the global health agenda.