https://orcid.org/0000-0002-8508-6282
Figures
Abstract
In low- and lower-middle-income countries (LLMICs), delivering equitable kidney care presents substantial challenges, resulting in significant disparities in disease management and treatment outcomes for people with kidney failure. This comprehensive report leveraged data from the International Society of Nephrology-Global Kidney Health Atlas (ISN-GKHA), to provide a detailed update on the landscape of kidney replacement therapy (KRT) in LLMICs. Among the 65 participating LLMICs, reimbursement for KRT (publicly funded by the government and free at the point of delivery) was available in 28%, 15%, and 8% for hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT), respectively. Additionally, while 56% and 28% of LLMICs reported the capacity to provide quality HD and PD, only 41% reported accessibility to chronic dialysis, defined as >50% of the national population being able to access KRT, and a mere 5% LLMICs reported accessibility to KT. Workforce shortages in nephrology further compound these challenges. Kidney registries and comprehensive policies for non-communicable diseases and chronic kidney disease care were limited in LLMICs. A comprehensive and cost-effective approach is crucial to address these challenges. Collaboration at global, regional, country, and individual levels is essential to enhance the quality of kidney care across LLMICs.
Citation: Nkunu V, Tungsanga S, Diongole HM, Sarki A, Arruebo S, Caskey FJ, et al. (2024) Landscape of kidney replacement therapy provision in low- and lower-middle income countries: A multinational study from the ISN-GKHA. PLOS Glob Public Health 4(12): e0003979. https://doi.org/10.1371/journal.pgph.0003979
Editor: Anil Gumber, Sheffield Hallam University, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
Received: March 27, 2024; Accepted: November 5, 2024; Published: December 2, 2024
Copyright: © 2024 Nkunu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The dataset has been included in the Supplementary Information.
Funding: The ISN-GKHA work was supported by the International Society of Nephrology (ISN) (grant RES0033080 to AKB at the University of Alberta). The author(s) received no specific funding for this work, except for SA, SD, and JD, who are employees of the ISN; the ISN provided support to SA, SD, and JD in the form of salaries. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests. ST reports Fellowship grants from the International Society of Nephrology-Salmasi Family and the Kidney Foundation of Thailand, outside the submitted work. SA, SD, and JD report personal fees (salaries) from The International Society of Nephrology, as employees. VJ reports personal fees from GSK, Astra Zeneca, Baxter Healthcare, Visterra, Biocryst, Chinook, Vera, and Bayer, paid to his institution, 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 have nothing to declare. This does not alter our adherence to PLOS Global Public Health policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
Introduction
Chronic kidney disease (CKD), particularly when it advances to kidney failure, is a significant global health burden [1]. The difficulties posed by kidney failure are more complex to manage in settings with limited resources [2, 3]. Low-income (LICs) and lower-middle-income (LMICs) countries (LLMICs) face challenges in providing equitable kidney care, leading to disparities in disease management, quality of care, treatment outcomes, and overall patient well-being [4]. These disparities stem from fundamental limitations in the kidney health system infrastructure across LLMICs. Constraints on healthcare expenditure and resource allocation impede access to kidney replacement therapy (KRT), including hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT), leaving many people struggling to receive essential care [5]. Moreover, these healthcare systems often lack comprehensive kidney registries, reliable data, and sufficient resources, including trained personnel and specialized equipment [6, 7]. The inadequate availability and capacity of services compromise the overall quality of kidney care in LLMICs.
Recognizing the urgent need to address these inequities, the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) Project was launched as a comprehensive, multinational survey to map the existing capacity of kidney care systems across different world regions. This manuscript leverages data from the ISN-GKHA to describe the organization, processes, and structures for the care of people with kidney failure living in LLMICs [8]. We aimed to descriptively compare the findings from LLMICs with those from high-income countries (HICs) to highlight the areas that required targeted interventions, aiming to elevate the quality of global kidney care.
Materials and methods
The ISN-GKHA employed two strategies to gather data at a country level. The first part was from an in-depth literature review of published data, grey literature, kidney registries, and databases to find the prevalence of CKD, incidence and prevalence of treated kidney failure, cost of KRT, and healthcare budgets. The second part was based on a multinational survey. The detailed methods have been previously published [8, 9].
Survey development, validation, and administration
The survey questionnaire underwent development and validation through consultations with relevant experts, the ISN Executive Committee, and ISN regional leaders. Administered as an online questionnaire through REDCap (www.project-redcap.org), the survey was distributed between June 1 and September 30, 2022 via the ISN’s 10 regional boards, encompassing the following regions: Africa, Eastern and Central Europe, Latin America, the Middle East, North America and the Caribbean, North and East Asia, Oceania and South East Asia (OSEA), Newly Independent States (NIS) and Russia, South Asia, and Western Europe.
The ISN-GKHA working group, in collaboration with ISN regional boards and national leaders, conducted thorough follow-ups via email and telephone to secure comprehensive survey responses. In each participating country, we included at least three key stakeholders knowledgeable about the status and scope of national kidney care practices. These stakeholders included a nephrology society leader, a healthcare policymaker, and an advocate from a patient representative organization.
Data handling and reporting
Responses from surveys conducted in French and Spanish were translated into English by certified translators. To maintain data accuracy, internal validation of the responses was carried out by each key stakeholder. External validation was then performed by ISN regional leaders, who were consulted to evaluate the consistency and quality of the compiled data. Any discrepancies identified during the review process were systematically addressed through follow-up inquiries with survey stakeholders. Further validation at national and regional levels included cross-referencing the findings with published literature, government reports, and input from survey respondents. The data from individual surveys were extracted and cleaned using Microsoft Excel. Subsequently, the cleaned data were consolidated into a unified database, securely maintained in a computer system with automated backup protocols.
Definitions of key variables
The key variables examined various facets of KRT and related factors. These included an assessment of funding and cost of KRT, gaps in total and government health budgets, the prevalence of treated KRT, and the availability of centers for provision of KRT. The accessibility to KRT was evaluated based on whether >50% of the national population could access KRT. The assessment of the capacity of quality KRT involved the availability of adequate HD frequency, focusing on the capacity for a 3-4-hour HD session thrice weekly. For PD, the assessment considered the capacity for four daily exchanges on continuous ambulatory PD (CAPD) or equivalent cycles on automated PD. Additionally, the study explored health information systems (HD, PD, and KT registries) as well as policy and advocacy elements, including the availability of non-communicable diseases (NCDs), CKD-specific policies, and the recognition of KRT as a health priority.
Data analysis
The statistical analysis was performed utilizing STATA 17 software (Stata Corporation, 2017). The analysis was conducted at the country level, and the outcomes were presented descriptively, including counts with percentages or medians with interquartile ranges (IQR), as appropriate. Results were stratified based on the ISN region [10] and the World Bank income group, determined by the Gross National Income (GNI) per capita [11] as of April 2022. The findings in LICs and LMICs were compared to those in HICs as a standard reference for an ideal setting.
Results
Survey response
Of 167 countries which provided survey responses to the ISN-GKHA, 65 were LLMICs, comprising 20 (31%) LICs and 45 (69%) LMICs. The participating countries were distributed across various ISN regions, including Africa (n = 36), OSEA (n = 10), South Asia (n = 7), Latin America (n = 4), the Middle East (n = 4), and NIS and Russia (n = 4) (S1 Table).
Funding and cost of KRT
Literature review data for health funding were available from 24 LICs and 43 LMICs. The median total and government health budgets per capita were US$43 and US$9 (21%) for LICs and US$85 and US$35 (41%) for LMICs, in contrast to US$2218 and US$1642 (74%) in HICs (Fig 1A and S2 Table) [12]. The median annual costs of HD were US$9064.8 and US$10,114.5 in LICs and LMICs, respectively, compared to US$37,685.4 for HICs. The median annual costs of PD were US$30,064.4 and US$7005.1 in LICs and LMICs, respectively, compared to US$27,206 for HICs. For KT, the median costs in the first year were US$18,269.1 and US$13,013.3 in LICs and LMICs, respectively, compared to US$71,445.6 for HICs. The median annual costs of KT in the later years were US$13,126.3 and US$5994 in LICs and LMICs, respectively, compared to US$17,996 for HICs (Fig 1B and S2 Table) [13–99].
Total healthcare budget and funding for kidney replacement therapy in low- and lower-middle-income countries compared to high-income countries: (A) health budget, (B) cost of kidney replacement therapy, and (C) funding structures for KRT [12–99]. Abbreviations: HD = hemodialysis; KRT = kidney replacement therapy; KT = kidney transplantation; LICs = low-income countries; LMICs = lower-middle-income countries; PD = peritoneal dialysis; USD = United States Dollar.
The survey revealed that only 25% (n = 5) and 29% (n = 13) of LICs and LMICs, respectively, had chronic HD publicly funded by the government and provided free at the point of delivery, compared to 62% (n = 39) in HICs. Solely private and out-of-pocket funding for HD was reported in 10% (n = 2) of LICs and 11% (n = 5) of LMICs. For chronic PD, only 15% (n = 3) and 16% (n = 7) of LICs and LMICs, respectively, had government-funded care that was free at the point of delivery, contrasting with 67% (n = 42) in HICs. Solely private and out-of-pocket funding for HD was reported in 5% (n = 1) of LICs and 16% (n = 7) of LMICs. KT was funded via public system (government funding and free at the point of delivery) in 15% (n = 3) and 4% (n = 2) of LICs and LMICs, respectively, compared to 60% (n = 38) of HICs. Solely private and out-of-pocket funding for HD was reported in 25% (n = 5) of LICs and 20% (n = 9) of LMICs. In HICs, no solely private reimbursement was reported for HD, PD, or KT (Fig 1C and S2 Table).
Availability of KRT
The prevalence of KRT revealed substantial disparities across LLMICs and HICs. The prevalence of chronic HD in LICs and LMICs was lower, with median values of 5.1 [1.2, 67.9] and 34.6 [10.1, 211.4] per million population (PMP), compared to 523.4 [355.7, 819.7] PMP in HICs. The prevalence of chronic PD also followed this pattern, with reported median values of 0.7 [0.0, 2.5] PMP in LICs, 1.3 [0.0, 10.8] PMP in LMICs, and 56.2 [37.9, 86.2] PMP in HICs. For KT, data were unavailable for LICs, while LMICs reported a median prevalence of 12 [5.5, 66.0] PMP, compared to 417 [279.0, 565.8] PMP in HICs (Fig 2 and S3 Table) [99–118].
Abbreviations: HD = hemodialysis; KRT = kidney replacement therapy; KT = kidney transplantation; NA = data not available; PD = peritoneal dialysis; PMP = per million population.
Regarding the availability of HD centers, LICs and LMICs had median reported values of 0.3 [0.2, 0.6] PMP and 1.9 [0.8, 5.5] PMP, compared to 9.31 [4.8, 16.4] PMP in HICs. Chronic PD centers followed a similar pattern, with 0.1 [0.1, 0.2] PMP in LICs, 0.3 [0.1, 0.5] PMP in LMICs, and 2.7 [1.8, 4.1] PMP in HICs. For KT, the reported median availabilities were 0.1 [0.0, 0.2] PMP in LICs, 0.2 [0.1, 0.4] PMP in LMICs, and 0.6 [0.4, 1.0] PMP in HICs (Fig 2 and S3 Table).
Accessibility and capacity of KRT
The accessibility to chronic dialysis, evaluated based on whether >50% of the national population could access KRT, showed variations, with 32% (n = 6) in LICs, 45% (n = 20) in LMICs, and 98% (n = 62) in HICs. Accessibility to KT was reported as 5% (n = 1) in LICs, 5% (n = 2) in LMICs, and 56% (n = 35) in HICs (Fig 3 and S3 Table). The variability of access to chronic dialysis showed a within-country variation in 61% (n = 11) in LICs, 54% (n = 22) in LMICs, and 11% (n = 7) in HICs. The impact of patient characteristics (age, gender, employment status) on access to chronic dialysis was reported in 33% (n = 6) of LICs, 39% (n = 16) of LMICs, and 8% (n = 5) of HICs. The variability in the access to KT also showed within-country variation in 14% (n = 1) in LICs, 37% (n = 10) in LMICs, and 16% (n = 10) in HICs. The variation in KT access influenced by patient characteristics was reported in 29% (n = 2) of LICs, 48% (n = 13) of LMICs, and 28% (n = 17) of HICs.
Abbreviations: HD = hemodialysis; KRT = kidney replacement therapy; KT = kidney transplantation; PD = peritoneal dialysis; PMP = per million population.
The capacity to provide quality chronic HD (3-4-hour HD session thrice weekly) was reported to be 37% in LICs and 64% in LMICs, compared to 97% in HICs. The capacity to provide quality chronic PD (defined as four daily exchanges on continuous ambulatory PD [CAPD] or equivalent cycles on automated PD) was reported as 11% in LICs and 36% in LMICs, compared to 92% in HICs.
Workforce for kidney care
The median prevalence of nephrologists was 0.3 PMP in LICs, 1.8 PMP in LMICs, and 25.3 PMP in HICs. The percentages of nephrologists who were female were 12% in LICs, 25% in LMICs, and 42% in HICs (Fig 3). Significant shortages of nephrologists were reported in 90% of LICs, 80% of LMICs, and 51% of HICs. Transplant surgeon shortages were reported in 90% of LICs, 80% of LMICs, and 38% of HICs. Countries reported limitations in the availability of dialysis nurses, whereby shortages were reported in 70% of LICs, 64% of LMICs, and 52% of HICs. Dialysis technicians were reported as being in short supply in 65% of LICs, 64% of LMICs, and 22% of HICs. The availability of transplant coordinators was also reported to be limited in 80% of LICs, 76% of LMICs, and 25% of HICs. Dietitians were reported to be in short supply in 90% of LICs, 76% of LMICs, and 38% of HICs (S4 Table).
Health information systems and structures for policies and advocacy for KRT provision
Health information systems, including registries for chronic dialysis, were reported to be available in 22% of LICs and 39% of LMICs compared to 81% of HICs. KT registries were unavailable in all LICs and in 70% of LMICs compared to 20% of HICs. Regarding the availability of policies and advocacies for KRT, 44% of LICs reported national policies for NCDs, 11% had CKD-specific policies, and 44% recognized KRT as a health priority. In LMICs, these figures were 57%, 25%, and 66%, respectively. In contrast to HICs, 65% had national policies for NCDs, 49% had CKD-specific policies, and 70% recognized KRT as a health priority (Fig 4 and S3 Table).
Abbreviations: CKD, chronic kidney disease; KRT, kidney replacement therapy; KT, kidney transplantation; NCD, non-communicable diseases.
Discussion
This analysis revealed significant disparities in the organization of and structures for KRT provision in LICs and LMICs globally. There were significant gaps in funding, capacity for care (KRT centers) and distribution, accessibility to KRT, capacity for quality KRT, workforce, and health information systems for quality assurance and monitoring in KRT provision.
The major disparity we noted was in total healthcare financing (not restricted to KRT) with a substantially lower allocation to government health budgets in LICs, highlighting the under-investment these countries make in providing comprehensive healthcare, including KRT. This finding aligns with the previously reported barriers to universal health coverage, particularly in Africa and South Asia [119, 120]. The universal coverage model observed in HICs, frequently achieved through prepayment schemes, was consistent with our survey findings, indicating that none of the participating countries solely rely on out-of-pocket reimbursement across all KRT modalities [121]. However, implementing such an approach in LLMICs proves challenging due to variations in employment rates and financial security. Governments may consider cost-sharing or health insurance options to enhance access to quality care for people with kidney failure and mobilize funds [122, 123]. Nevertheless, while cost-sharing or health insurance options increase service availability, they could lead to negative health outcomes as some people may discontinue treatment or receive suboptimal care [124–128]. Considering that the annual cost per treated person in LLMICs significantly surpasses the average income [129], over-reliance on private reimbursement remains a significant barrier to expanding access to KRT services. While certain countries receive support from non-governmental organizations, these resources are not universally accessible [130, 131]. In addition, political conflict, instability, corruption, wars, and inflation may hinder effective budget allocation [132]. Notably, the median cost per capita for KRT provision was generally lower in the LLMICs compared to HICs, likely influenced by factors such as lower labor and infrastructure costs. Regulatory variations, pharmaceutical pricing, and limited use of technological advancements also impact costs. However, it is important to note that lower costs do not necessarily reflect the quality of care. Therefore, there is substantial potential for any incremental funding to enhance KRT provision in the LLMICs considerably.
In addition to healthcare financing, access to KRT was influenced by important geographic and patient-related factors. People residing in remote areas, women, older individuals, economically disadvantaged people, and those with higher severity of kidney failure face lower accessibility to KRT [133, 134]. Our findings indicated that the impact of patient characteristics on KRT accessibility is more pronounced in LLMICs, which often requires healthcare providers to make challenging decisions about which individuals will receive access to crucial kidney care [135]. The capacity to provide quality HD and PD in LLMICs remains suboptimal, resulting in inadequate dialysis services despite the availability of these modalities [63]. Moreover, although home-based dialysis (especially PD) could help to address rural transportation, it is infrequently available in LLMICs due to the high cost of PD fluids, largely due to the need to import consumables, insufficient PD training, challenges associated with PD outcomes, and a shortage of healthcare workforce [136]. Although it is well-established that home dialysis is cost-effective in HICs [137, 138], the data in LLMICs remain limited [139].
Another major barrier to optimal KRT provision is the availability and distribution of an effective workforce. LLMICs exhibited notably lower median prevalence of nephrologists and essential healthcare professionals for dialysis. The workforce shortage specifically related to KT, including transplant surgeons and coordinators, was reported to be higher. This suggests a potential deficit in specialized healthcare professionals crucial for delivering high-quality KRT services, especially KT. This is largely driven by limitations in working conditions and resources as well as opportunities for career growth hindering the retention of qualified workers [140]. Expanding nephrology training opportunities for healthcare providers and task shifting could contribute to the development of a stronger and more skilled nephrology workforce [7, 141, 142].
Additional challenges toward optimal and high-quality KRT provision in these settings is the lack of data monitoring systems. Kidney registries are crucial for developing a robust surveillance system for kidney care. In settings with limited resources, registries are pivotal in monitoring restricted modalities, such as dialysis and KT. They provide a comprehensive perspective on resource allocation and help identify areas for improvement [143, 144].
We have identified important gaps in care, and solutions are needed. Despite reported recognition of KRT as a health priority in LLMICs, national policies for NCDs and CKD-specific policies remain limited. Unlike UMICs or HICs, where innovative technologies enhance kidney care, LLMICs require comprehensive and cost-effective strategies that are practical in their context. This approach encompasses CKD prevention, early detection, and effective management to slow the progression to kidney failure [145, 146]. Public education and enhancing health literacy are crucial to empower people so that they can make informed health decisions [147]. International organizations, such as the Kidney Disease: Improving Global Outcomes (KDIGO) and the ISN, play a pivotal role in supporting LLMICs [148]. The ISN offers various programs to support workforce development, including fellowship grants, sister kidney center initiatives, and online teaching modules. The ISN’s SharE-RR Toolkit provides guidance on establishing registries to monitor kidney health, with special attention to the unique challenges in LLMICs. Collaboration at the global, regional, country (nephrology society), and individual levels should be prioritized to ensure the success of these initiatives [134, 149].
This analysis enriches the ISN-GKHA reports by providing a focused exploration exclusively on LLMICs, offering a comprehensive examination tailored to the unique healthcare challenges and landscapes of these regions. However, as a sub-analysis of the ISN-GKHA survey, it is based on cross-sectional data, capturing large-scale global trends but potentially lacking detailed insights at the individual country level. The analysis primarily adopts an economic lens, potentially overlooking important contextual factors such as human development index or demographic aspects. Incorporating these additional dimensions could provide a more nuanced understanding of the complex interactions influencing kidney health outcomes and disparities within LLMIC settings.
Conclusions
We noted significant disparities in the organization, capacity, and structures for providing optimal KRT for people living with kidney failure in LLMICs, including workforce shortages, limited funding, and limited government responses (in terms of policies and strategies) toward prevention. Kidney diseases have a significant impact on population health and the economy. Given the burden of kidney failure and challenges in kidney care in LLMICs, there is a compelling need for the global nephrology community to persist in targeted efforts to close these gaps in care. Addressing these disparities will require collaborative efforts on multiple fronts, involving international, regional, and national stakeholder organizations, and meaningful public engagement.
Supporting information
S1 Table. List of participating low- and lower-middle-income countries by World Bank income groups and ISN regions.
https://doi.org/10.1371/journal.pgph.0003979.s001
(DOCX)
S2 Table. Global healthcare funding and cost of kidney replacement therapy in low- and lower-middle-income countries [12–99].
https://doi.org/10.1371/journal.pgph.0003979.s002
(DOCX)
S3 Table. Organization and structures for kidney replacement therapy in low- and lower-middle-income countries.
https://doi.org/10.1371/journal.pgph.0003979.s003
(DOCX)
S4 Table. Workforce for kidney care in low- and lower-middle-income countries.
https://doi.org/10.1371/journal.pgph.0003979.s004
(DOCX)
S1 Checklist. Inclusivity in global research.
https://doi.org/10.1371/journal.pgph.0003979.s005
(DOCX)
Acknowledgments
The International Society of Nephrology provided administrative support for the design and implementation of the survey and data collection activities. The authors appreciate the support from the ISN’s Executive Committee, especially ISN Executive Director Charu Malik, ISN regional leadership, and ISN Affiliated Society leaders at the regional and country levels for their help with the ISN-GKHA. The authors also thank the Alberta Kidney Disease Network staff, in particular Ghenette Houston and Sophanny Tiv.
References
- 1.
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–33. doi: 10.1016/S0140-6736(20)30045-3.
- 2. Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975–82. pmid:25777665
- 3. Ulasi II, Awobusuyi O, Nayak S, Ramachandran R, Musso CG, Depine SA, et al. Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives. Semin Nephrol. 2022;42(5):151336. pmid:37058859
- 4. Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021;52(2):98–107. pmid:33752206
- 5. Bello AK, Alrukhaimi M, Ashuntantang GE, Bellorin-Font E, Benghanem Gharbi M, Braam B, et al. Global overview of health systems oversight and financing for kidney care. Kidney Int Suppl (2011). 2018;8(2):41–51. pmid:30675438
- 6. Crews DC, Bello AK, Saadi G, World Kidney Day Steering C. Burden, Access, and Disparities in Kidney Disease. Kidney Int Rep. 2019;4(3):372–9. pmid:30899864
- 7. Okpechi IG, Tungsanga S, Ghimire A, Johnson DW, Bello AK. Expanding the global nephrology workforce. Nat Rev Nephrol. 2024;20(3):151–2. pmid:38200139
- 8. Bello AK, Okpechi IG, Levin A, Ye F, Damster S, Arruebo S, et al. An update on the global disparities in kidney disease burden and care across world countries and regions. Lancet Glob Health. 2024;12(3):e382–e95. pmid:38365413
- 9. Bello AK, Johnson DW, Feehally J, Harris D, Jindal K, Lunney M, et al. Global Kidney Health Atlas (GKHA): design and methods. Kidney Int Suppl (2011). 2017;7(2):145–53. pmid:30675429
- 10.
International Society of Nephrology. ISN Regions. [Cited June 1, 2022]. Available from: https://www.theisn.org/about-isn/governance/regional-boards/
- 11.
World Bank. World Bank country and lending groups—World Bank data help desk. [Accessed June 1, 2022]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519.
- 12.
The Institute for Health Metrics and Evaluation. Global Health Data Exchange. Global Expected Health Spending 2019–2050. [Accessed April 8, 2022]. Available from: https://ghdx.healthdata.org/record/ihme-data/global-expected-health-spending-2019-2050.
- 13. Bahadi A, Benbria S, Elkabbaj D. Cost of dialysis therapy by modality in Morocco: Cost-minimization study comparing peritoneal dialysis to hemodialysis. Ther Apher Dial. 2022 Oct;26(5):1052–1053. pmid:35294111
- 14. Boima V, Agyabeng K, Ganu V, Dey D, Yorke E, Amissah-Arthur MB, et al. Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS One. 2020 Dec 30;15(12):e0244437. pmid:33378327
- 15. Elsharif ME, Elsharif EG, Gadour WH. Costs of hemodialysis and kidney transplantation in Sudan: a single center experience. Iran J Kidney Dis. 2010 Oct;4(4):282–4. pmid:20852367
- 16. Haddiya I, Radoui A, Benamar L, Ezaitouni F, Ouzeddoun N, Bayahia R, et al. Ten years of renal transplantation in a Moroccan hospital: results and constraints. Transplant Proc. 2012 Dec;44(10):2976–81. pmid:23195009
- 17. Izeidi PPM, Nlandu YM, Lepira FB, Makulo JR, Engole YM, Mokoli VM, et al. Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective study in two centers. Hemodial Int. 2020 Jan;24(1):121–128. pmid:31750998
- 18. Kassa DA, Mekonnen S, Kebede A, Haile TG. Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia. Clinicoecon Outcomes Res. 2020 Jul 27;12:399–409. pmid:32821136
- 19. Lang JJ, Lombardi CV, James IA, Da Rocha-Afodu DB, Okwuonu CG, Ekwenna OO. A Payer’s Perspective: A Comparison and Simulation of the Costs of Hemodialysis Versus Living Donor Kidney Transplant for Patients With End-Stage Renal Disease in Nigeria. Transpl Int. 2022 Jul 20;35:10662. pmid:35935273
- 20. Mushi L, Krohn M, Flessa S. Cost of dialysis in Tanzania: evidence from the provider’s perspective. Health Econ Rev. 2015 Dec;5(1):28. pmid:26464023
- 21. Obadiah M, Carl S, Ahmed H. Kidney transplantation versus dialysis in Zimbabwe: a systematic review of the cost-effectiveness. Journal of The Egyptian Society of Nephrology and Transplantation. 2022; 22(2): 71–85.
- 22. Okafor C, Kankam C. Future options for the management of chronic kidney disease in Nigeria. pmid:22340645.
- 23. Soliman AR, Fathy A, Roshd D. The growing burden of end-stage renal disease in Egypt. Ren Fail. 2012;34(4): 425–8. pmid:22260432
- 24. Sumaili EK, Cohen EP, Zinga CV, Krzesinski JM, Pakasa NM, Nseka NM. High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo. BMC Nephrol. 2009 Jul 21;10:18. pmid:19622160
- 25. Toure AO, Balde MD, Diallo A, Camara S, Soumah AM, Sall AO, et al. The direct cost of dialysis supported by families for patients with chronic renal failure in Ouagadougou (Burkina Faso). BMC Nephrol. 2022 Jun 23;23(1):222. pmid:35739468
- 26. van der Tol A, Lameire N, Morton RL, Van Biesen W, Vanholder R. An International Analysis of Dialysis Services Reimbursement. Clin J Am Soc Nephrol. 2019 Jan 7;14(1):84–93. pmid:30545819
- 27. Yousif AO, Idris AKM, Awad MM, El-Samani EZ. Out-of-pocket payments by end-stage kidney disease patients on regular hemodialysis: Cost of illness analysis, experience from Sudan. Hemodial Int. 2021 Jan;25(1):123–130. pmid:33145981
- 28. Erek E, Sever MS, Akoglu E, Sariyar M, Bozfakioglu S, Apaydin S, et al. Cost of renal replacement therapy in Turkey. Nephrology (Carlton). 2004 Feb;9(1):33–8. pmid:14996307
- 29. Kaló Z, Járay J, Nagy J. Economic evaluation of kidney transplantation versus hemodialysis in patients with end-stage renal disease in Hungary. Prog Transplant. 2001 Sep;11(3):188–93. pmid:11949461
- 30. Kandus A, Arnol M, Bren AF. Survey of renal transplantation in Slovenia. Ther Apher Dial. 2009 Aug;13(4):264–7. pmid:19695056
- 31. Neretljak I, Sučić M, Kocman B, Knotek M. The Cost of Kidney Transplantation at the Merkur University Hospital, Zagreb, Croatia. Acta Clin Croat. 2021 Jun;60(2):178–183. pmid:34744266; PMCID: PMC8564849.
- 32. Perović S, Janković S. Renal transplantation vs hemodialysis: cost-effectiveness analysis. Vojnosanit Pregl. 2009 Aug;66(8):639–44. pmid:19780419
- 33. Rifatbegović Z, Trnačević S, Begić E, Nišlić E, Kovačević M. Organ Transplantation in Bosnia and Herzegovina. Transplantation. 2022 Sep 1;106(9):1703–1708. pmid:36001486
- 34. Arze Aimaretti L, Arze S. Preemptive Renal Transplantation-The Best Treatment Option for Terminal Chronic Renal Failure. Transplant Proc. 2016 Mar;48(2):609–11. pmid:27110013
- 35. Arredondo A, Rangel R, de Icaza E. Costo-efectividad de intervenciones para insuficiencia renal crónica terminal [Cost-effectiveness of interventions for end-stage renal disease]. Rev Saude Publica. 1998 Dec;32(6):556–65. Spanish. pmid:10349148
- 36. Arze S, Paz Zambrana S. Advances in Ethical, Social, and Economic Aspects of Chronic Renal Disease in Bolivia. Transplant Proc. 2016 Mar;48(2):559–63. pmid:27110002
- 37. Babakhani A, Guy SR, Falta EM, Elster EA, Jindal TR, Jindal RM. Surgeons bring RRT to patients in Guyana. Bull Am Coll Surg. 2013 Jun;98(6):17–27. pmid:23789195
- 38. Balshaw R, Machnicki G, Carreño CA, Toselli L, Otero A, Keown PA. Two-hour post-dose cyclosporine levels in renal transplantation in Argentina: a cost-effective strategy for reducing acute rejection. Transplant Proc. 2005 Mar;37(2):871–4. pmid:15848560
- 39. Cerdas M. Chronic kidney disease in Costa Rica. Kidney Int Suppl. 2005 Aug;(97):S31–3. pmid:16014096
- 40. Garcia P, Sánchez-Polo V. Global Dialysis Perspective: Guatemala. Kidney360. 2020 Sep 17;1(11):1300–1305. pmid:35372871
- 41. Méndez Chacón P, Camacho Bonilla M, Vidalón Fernández A. Trasplante y comercio de organos en Peru [Kidney transplantation and organ trade in Peru]. Nefrologia. 2006;26(5):527–37. Spanish.
- 42. Rosselli D, Rueda JD, Diaz CE. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease. Saudi J Kidney Dis Transpl. 2015 Jul-Aug;26(4):733–8. pmid:26178546
- 43. Saldarriaga EM, Bravo-Zúñiga J, Hurtado-Roca Y, Suarez V. Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru. Cost Eff Resour Alloc. 2021 Oct 10;19(1):70. pmid:34629084
- 44. Silva SB, Caulliraux HM, Araújo CA, Rocha E. Cost comparison of kidney transplant versus dialysis in Brazil. Cad Saude Publica. 2016 Jun 1;32(6):S0102-311X2016000605005. pmid:27383457
- 45. Torres I, Sippy R, Bardosh KL, Bhargava R, Lotto-Batista M, Bideaux AE, et al. Chronic kidney disease in Ecuador: An epidemiological and health system analysis of an emerging public health crisis. PLoS One. 2022 Mar 16;17(3):e0265395. pmid:35294504
- 46. Al Arrayed A, Al Tantawi M, Fareed E, Haider F, Abouna G. Renal transplant is an established and successful treatment for end-stage renal failure in Bahrain. Bahrain Med. Bull 2000; 22(2):60–63.
- 47. Al-Jedai A, Alsultan M, Almeshari K, Alshaibani K, Elgamal H, Alkortas D, et al. Cost analysis of kidney transplantation in highly sensitized recipients compared to intermittent maintenance hemodialysis. Ann Transplant. 2012 Dec 31;17(4):82–91. pmid:23274328
- 48. Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res. 2022 May 1;22(1):586. pmid:35501814
- 49. Batieha A, Abdallah S, Maghaireh M, Awad Z, Al-Akash N, Batieneh A, et al. Epidemiology and cost of haemodialysis in Jordan. East Mediterr Health J. 2007 May-Jun;13(3):654–63. pmid:17687839
- 50. Moradpour A, Hadian M, Tavakkoli M. Economic evaluation of end stage renal disease treatments in Iran. Clinical Epidemiology and Global Health. 2020 Mar; 8(1):199–204.
- 51. Sekkarie MA, Zanabli AR, Rifai AO, Murad LB, Al-Makki AA. The Syrian conflict: assessment of the ESRD system and response to hemodialysis needs during a humanitarian and medical crisis. Kidney Int. 2015 Feb;87(2):262–5. pmid:25635715
- 52. Younis M, Jabr S, Al-Khatib A, Forgione D, Hartmann M, Kisa A. A cost analysis of kidney replacement therapy options in Palestine. Inquiry. 2015 Mar 11;52:0046958015573494. pmid:25765018
- 53. Babloyan S, Voskanyan M, Shekherdimian S, Nazaryan H, Arakelyan S, Kurkchyan K, et al. Kidney Transplantation in Low- to Middle-Income Countries: Outcomes and Lessons Learned from Armenia. Ann Transplant. 2021 Sep 21;26:e930943. pmid:34545060
- 54.
Kolesnyk M, Stepanova N, Dudar I, Bagdasarova I, Fomina S. Nephrology in Ukraine. In: Moura-Neto JA, Divino-Filho JC, Ronco C, editors. Nephrology Worldwide. Basel: Springer Nature Switzerland AG; 2021. p. 675–865.
- 55. Saparbay J, Assykbayev M, Abdugafarov S, Zhakhina G, Abdrakhmanova S, Turganbekova A, et al. Kidney transplantation outcomes: Single center experience. Transplantation Reports 2022; 7(3): 100105.
- 56. Tataradze A, Managadze G, Beglarashvili L, Kipshidze N, Managadze L, Chkhotua A. Comparative Costs of Different Renal Replacement Therapies in Lower Middle Income Countries on the Example of Georgia. International Journal of Clinical Medicine. 2016; 7:437–444.
- 57. Adomakoh SA, Adi CN, Fraser HS, Nicholson GD. Dialysis in Barbados: the cost of hemodialysis provision at the Queen Elizabeth Hospital. Rev Panam Salud Publica. 2004 Nov;16(5):350–5. pmid:15729985
- 58. Barnieh L, Yilmaz S, McLaughlin K, Hemmelgarn BR, Klarenbach S, Manns BJ, et al. The cost of kidney transplant over time. Prog Transplant. 2014 Sep;24(3):257–62. pmid:25193726
- 59. Kramer H, Soyibo A, Forrester T, Boyne M, Markossian T, Durazo-Arvizu R, et al. The burden of chronic kidney disease and its major risk factors in Jamaica. Kidney Int. 2018 Nov;94(5):840–842. pmid:30348297
- 60. Wang JH, Hart A. Global Perspective on Kidney Transplantation: United States. Kidney360. 2021 Aug 19;2(11):1836–1839. pmid:35373000
- 61. Bhargava V, Jasuja S, Tang SC, Bhalla AK, Sagar G, Jha V, et al. Peritoneal dialysis: Status report in South and South East Asia. Nephrology (Carlton). 2021 Nov;26(11):898–906. pmid:34313370
- 62. Shimizu U, Saito S, Lings Y, Iino N, Kazama JJ, Akazawa K. Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan. J Med Econ. 2012;15(3):444–53. pmid:22250787
- 63. Tang SCW, Yu X, Chen HC, Kashihara N, Park HC, Liew A, et al. Dialysis Care and Dialysis Funding in Asia. Am J Kidney Dis. 2020 May;75(5):772–781. pmid:31699518
- 64. Tumurbaatar B, Nyamsuren D, Byambadorj B, Bayan-Undur D, Jambaljav L, Byambadash B, et al. Kidney transplantation in Mongolia using effective and economical immunosuppression ‐ a three-year experience. Ann Transplant. 2012 Jan-Mar;17(1):132–9. pmid:22466920
- 65. Zhang H, Zhang C, Zhu S, Ye H, Zhang D. Direct medical costs of end-stage kidney disease and renal replacement therapy: a cohort study in Guangzhou City, southern China. BMC Health Serv Res. 2020 Feb 14;20(1):122. pmid:32059726
- 66. Ashton T, Marshall MR. The organization and financing of dialysis and kidney transplantation services in New Zealand. Int J Health Care Finance Econ. 2007 Dec;7(4):233–52. pmid:17638073
- 67. Bavanandan S, Yap YC, Ahmad G, Wong HS, Azmi S, Goh A. The Cost and Utility of Renal Transplantation in Malaysia. Transplant Direct. 2015 Nov 20;1(10):e45. pmid:27500211
- 68. Hyodo T, Fukagawa M, Hirawa N, Isaka Y, Nakamoto H, Van Bui P, et al. Present status of renal replacement therapy in Asian countries as of 2017: Vietnam, Myanmar, and Cambodia. Ren Replace Ther. 2020; 6:65.
- 69. Khan BA, Singh T, Ng ALC, Teo RZC. Health economics of kidney replacement therapy in Singapore: Taking stock and looking ahead. Ann Acad Med Singap. 2022 Apr;51(4):236–240. pmid:35506407
- 70. Kristina S, Endarti D, Andayani T, Aditama H. Cost of illness of hemodialysis in Indonesia: A survey from eight hospitals in Indonesia. Int J Pharm Res 2020; 13:2815–20.
- 71. Lim CY, Tan J. Global Dialysis Perspective: Brunei Darussalam. Kidney360. 2021 Apr 19;2(6):1027–1030. pmid:35373093
- 72. Sitprija V. Nephrology in South East Asia: fact and concept. Kidney Int Suppl. 2003 Feb;(83):S128–30. pmid:12864891
- 73. Vareesangthip K, Deerochanawong C, Thongsuk D, Pojchaijongdee N, Permsuwan U. Cost-Utility Analysis of Dapagliflozin as an Add-on to Standard of Care for Patients with Chronic Kidney Disease in Thailand. Adv Ther. 2022 Mar;39(3):1279–1292. pmid:35038121
- 74. Yang F, Lau T, Luo N. Cost-effectiveness of haemodialysis and peritoneal dialysis for patients with end-stage renal disease in Singapore. Nephrology (Carlton). 2016 Aug;21(8):669–77. pmid:26566750
- 75. Ying T, Tran A, Webster AC, Klarenbach SW, Gill J, Chadban S, et al. Screening for Asymptomatic Coronary Artery Disease in Waitlisted Kidney Transplant Candidates: A Cost-Utility Analysis. Am J Kidney Dis. 2020 May;75(5):693–704. pmid:31810731
- 76. Gupta D, Jyani G, Ramachandran R, Bahuguna P, Ameel M, Dahiya BB, et al. Peritoneal dialysis-first initiative in India: a cost-effectiveness analysis. Clin Kidney J. 2021 Jul 15;15(1):128–135. pmid:35035943
- 77. Jindal RM, Falta EM, Baines L, Elster EA. Health policy for renal replacement therapy in developing countries. Journal of Healthcare, Science & The Humanities 2011: 1(1):41–54.
- 78. Rizvi SA, Naqvi SA, Zafar MN, Hussain Z, Hashmi A, Hussain M, et al. A renal transplantation model for developing countries. Am J Transplant. 2011 Nov;11(11):2302–7. pmid:21883911
- 79. Sharma I, Bhattarai M, Sigdel MR. Global Dialysis Perspective: Nepal. Kidney360. 2022 Apr 27;3(7):1269–1274. pmid:35919532
- 80. Wijewickrama ES, Herath N. Global Dialysis Perspective: Sri Lanka. Kidney360. 2022 Jul 8;3(9):1603–1606. pmid:36245652
- 81. Cavallo MC, Sepe V, Conte F, Abelli M, Ticozzelli E, Bottazzi A, et al. Cost-effectiveness of kidney transplantation from DCD in Italy. Transplant Proc. 2014 Dec;46(10):3289–96. pmid:25498039
- 82. Ferguson TW, Harper GD, Milad JE, Komenda PVJ. Cost of the quanta SC+ hemodialysis system for self-care in the United Kingdom. Hemodial Int. 2022 Jul;26(3):287–294. pmid:35001500
- 83. Häckl D, Kossack N, Schoenfelder T. Prävalenz, Kosten der Versorgung und Formen des dialysepflichtigen chronischen Nierenversagens in Deutschland: Vergleich der Dialyseversorgung innerhalb und außerhalb stationärer Pflegeeinrichtungen [Prevalence, Costs of Medical Treatment and Modalities of Dialysis-dependent Chronic Renal Failure in Germany: Comparison of Dialysis Care of Nursing Home Residents and in Outpatient Units]. Gesundheitswesen. 2021 Oct;83(10):818–828. German. pmid:33450773
- 84. Haller M, Gutjahr G, Kramar R, Harnoncourt F, Oberbauer R. Cost-effectiveness analysis of renal replacement therapy in Austria. Nephrol Dial Transplant. 2011 Sep;26(9):2988–95. pmid:21310740
- 85. Helanterä I, Isola T, Lehtonen TK, Åberg F, Lempinen M, Isoniemi H. Association of Clinical Factors with the Costs of Kidney Transplantation in the Current Era. Ann Transplant. 2019 Jul 2;24:393–400. pmid:31263093
- 86. Jakobsen A, Albrechtsen D, Sødal G, Flatmark A, Fauchald P, Vartdal F. Kostnader ved uremikeromsorg. Hva koster nyretransplantasjon? [Costs of care in uremia. How much does kidney transplantation cost?]. Tidsskr Nor Laegeforen 1990; 110(3):338–41.
- 87. Jarl J, Desatnik P, Peetz Hansson U, Prütz KG, Gerdtham UG. Do kidney transplantations save money? A study using a before-after design and multiple register-based data from Sweden. Clin Kidney J. 2018 Apr;11(2):283–288. pmid:29644072
- 88. Jensen CE, Sørensen P, Petersen KD. In Denmark kidney transplantation is more cost-effective than dialysis. Dan Med J. 2014 Mar;61(3):A4796. pmid:24814915
- 89. Jürgensen JS, Ikenberg R, Greiner RA, Hösel V. Cost-effectiveness of modern mTOR inhibitor based immunosuppression compared to the standard of care after renal transplantation in Germany. Eur J Health Econ. 2015 May;16(4):377–90. pmid:24728542
- 90. Kerr M, Bray B, Medcalf J, O’Donoghue DJ, Matthews B. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant. 2012 Oct;27 Suppl 3(Suppl 3):iii73-80. pmid:22815543
- 91. Li B, Cairns JA, Fotheringham J, Tomson CR, Forsythe JL, Watson C, et al. Understanding cost of care for patients on renal replacement therapy: looking beyond fixed tariffs. Nephrol Dial Transplant. 2015 Oct;30(10):1726–34. pmid:26071229
- 92. Mohnen SM, van Oosten MJM, Los J, Leegte MJH, Jager KJ, Hemmelder MH, et al. Healthcare costs of patients on different renal replacement modalities ‐ Analysis of Dutch health insurance claims data. PLoS One. 2019 Aug 15;14(8):e0220800. pmid:31415578
- 93. Roberts G, Holmes J, Williams G, Chess J, Hartfiel N, Charles JM, et al. Current costs of dialysis modalities: A comprehensive analysis within the United Kingdom. Perit Dial Int. 2022 Nov;42(6):578–584. pmid:35068280
- 94. Rocha MJ, Ferreira S, Martins LS, Almeida M, Dias L, Pedroso S, et al. Cost analysis of renal replacement therapy by transplant in a system of bundled payment of dialysis. Clin Transplant. 2012 Jul-Aug;26(4):529–31. pmid:22211715
- 95. Sandoz MS, Ess SM, Keusch GW, Schwenkglenks M, Szucs TD. Prevalence and direct medical costs of end-stage renal disease in patients with type 2 diabetes mellitus in Switzerland for 2001. Swiss Med Wkly. 2004 Aug 7;134(31–32):448–58. pmid:15389348
- 96. Van Biesen W, Lameire N, Peeters P, Vanholder R. Belgium’s mixed private/public health care system and its impact on the cost of end-stage renal disease. Int J Health Care Finance Econ. 2007 Sep;7(2–3):133–48. pmid:17638074
- 97. Villa G, Rodríguez-Carmona A, Fernández-Ortiz L, Cuervo J, Rebollo P, Otero A, et al. Cost analysis of the Spanish renal replacement therapy programme. Nephrol Dial Transplant. 2011 Nov;26(11):3709–14. pmid:21427072
- 98. Zambrowski JJ. Coût de la dialyse [Cost of dialysis in France]. Nephrol Ther 2016; 12 Suppl 1:S95–97.
- 99. Abu-Aisha H, Elamin S. Peritoneal dialysis in Africa. Perit Dial Int. 2010 Jan-Feb;30(1):23–8. pmid:20056975
- 100. Jain AK, Blake P, Cordy P, Garg AX. Global trends in rates of peritoneal dialysis. J Am Soc Nephrol. 2012 Mar;23(3):533–44. pmid:22302194
- 101.
European Renal Association. ERA Registry. Annual Report 2019. [Accessed April 8, 2022]. Available from: https://www.era-online.org/wp-content/uploads/2022/11/ERA-Registry-Annual-Report-2019.pdf.
- 102. Seyahi N, Kocyigit I, Ates K, Suleymanlar G. Current Status of Renal Replacement Therapy in Turkey: A Summary of 2020 Turkish Society of Nephrology Registry Report. [Accessed April 8, 2022]. Available from: https://turkjnephrol.org/en/current-status-of-renal-replacement-therapy-in-turkey-a-summary-of-2020-turkish-society-of-nephrology-registry-report-137038.
- 103.
United States Renal Data System. 2019 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2019. [Accessed April 8, 2022]. Available from: https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/usrds/prior-data-reports/2019.
- 104. Nerbass FB, Lima HDN, Thomé FS, Vieira Neto OM, Lugon JR, Sesso R. Brazilian Dialysis Survey 2020. J Bras Nefrol. 2022;44(3):349–357. pmid:35212702
- 105. Luxardo R, Ceretta L, González-Bedat M, Ferreiro A, Rosa-Diez G. The Latin American Dialysis and Renal Transplantation Registry: report 2019. Clin Kidney J. 2021;15(3):425–431. pmid:35211302
- 106. Alalawi F, Ahmed M, AlNour H, Noralla M, Alhadari A. Epidemiology of end-stage renal disease in Dubai: Single-center data. Saudi J Kidney Dis Transpl. 2017;28(5):1119–1125. pmid:28937072
- 107.
Canadian Organ Replcement Register (CORR). [Accessed April 8, 2022]. Available from: https://www.cihi.ca/en/canadian-organ-replacement-register-corr.
- 108. Soyibo AK, Barton EN. Report from the Caribbean renal registry, 2006. West Indian Med J. 2007;56(4):355–363. pmid:18198742
- 109. Gan L, Zuo L. Current ESRD burden and its future trend in Beijing, China. Clin Nephrol. 2015;83(7 Suppl 1):17–20. pmid:25725236
- 110.
Thailand Renal Replacement Therapy: Year 2016–2019. [Accessed April 8, 2022]. Available from: https://www.nephrothai.org/wp-content/uploads/2021/01/1.TRT-Annual-report-2016-2019.pdf.
- 111.
Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) 43rd Annual Report 2020 (Data to 2019). [Accessed April 8, 2022]. Available from: https://www.anzdata.org.au/report/anzdata-43rd-annual-report-2020-data-to-2019/.
- 112.
Singapore Renal Registry Annual Report 2021. [Accessed April 8, 2022]. Available from: https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/srr-annual-report-2021.pdf?sfvrsn=7bbef4a_0.
- 113.
Finnish Registry for Kidney Diseases Report 2020. [Accessed April 8, 2022]. Available from: https://www.muma.fi/files/5627/Finnish_Registry_for_Kidney_Diseases_Report_2020.pdf.
- 114.
Nefrovisie, Utrecht, the Netherlands 2021. Renine Registry Annual Report 2021. [Accessed April 8, 2022]. Available from: https://www.nefrovisie.nl/wp-content/uploads/2022/02/Jaarrapportage_Renine_2020_web.pdf.
- 115.
The Norwegian Renal Registry. Annual Report 2020. [Accessed April 8, 2022]. Available from: https://www.nephro.no/nnr/AARSRAPPORT_NNR_2020.pdf.
- 116.
The Renal Association. UK Renal Registry 23rd Annual Report. [Accessed April 8, 2022]. Available from: https://ukkidney.org/sites/renal.org/files/23rd_UKRR_ANNUAL_REPORT.pdf.
- 117.
Global Observatory on Donation and Transplantation. [Accessed April 8, 2022]. Available from: http://www.transplant-observatory.org/data-charts-and-tables/.
- 118. Davids MR, Jardine T, Marais N, Sebastian S, Davids T, Jacobs JC. South African Renal Registry Annual Report 2019. Afr J Nephrol. 2021;24(1):95–106. [Accessed April 8, 2022]. Available from: https://www.journals.ac.za/ajn/article/view/4980.
- 119. Ashu JT, Mwangi J, Subramani S, Kaseje D, Ashuntantang G, Luyckx VA. Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure. Int J Equity Health. 2022;21(1):126. pmid:36064532
- 120. Essue BM, Jha V, John O, Knight J, Jan S. Universal health coverage and chronic kidney disease in India. Bull World Health Organ. 2018;96(7):442. pmid:29962543
- 121. Vanholder R, Davenport A, Hannedouche T, Kooman J, Kribben A, Lameire N, et al. Reimbursement of dialysis: a comparison of seven countries. J Am Soc Nephrol. 2012;23(8):1291–8. pmid:22677554
- 122. Harris DCH, Davies SJ, Finkelstein FO, Jha V, Donner JA, Abraham G, et al. Increasing access to integrated ESKD care as part of universal health coverage. Kidney Int. 2019;95(4S):S1–S33. pmid:30904051
- 123. Sangthawan P, Klyprayong P, Geater SL, Tanvejsilp P, Anutrakulchai S, Boongird S, et al. The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai "Peritoneal Dialysis First Policy". Front Public Health. 2022;10:965808. pmid:36311589
- 124. Goudge J, Alaba OA, Govender V, Harris B, Nxumalo N, Chersich MF. Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme. Int J Equity Health. 2018;17(1):1. pmid:29301537
- 125. Dutta M, Husain Z. Does health insurance ensure equitable health outcomes? An analysis of hospital services usage in urban India. World Health Popul. 2013;14(4):38–50. pmid:24289968
- 126. Pettigrew LM, Mathauer I. Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995–2012 and policy implications for progress towards universal health coverage. Int J Equity Health. 2016;15:67. pmid:27089877
- 127. Kutzin J, Ibraimova A, Jakab M, O’Dougherty S. Bismarck meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan. Bull World Health Organ. 2009;87(7):549–54. pmid:19649370
- 128. Hidayat B, Thabrany H, Dong H, Sauerborn R. The effects of mandatory health insurance on equity in access to outpatient care in Indonesia. Health Policy Plan. 2004;19(5):322–35. pmid:15310667
- 129. Mushi L, Marschall P, Flessa S. The cost of dialysis in low and middle-income countries: a systematic review. BMC Health Serv Res. 2015;15:506. pmid:26563300
- 130. Tannor EK, Calice-Silva V. Kidney Health for All-Efforts in Low-Income Settings to Enhance Community Engagement, Kidney Health Awareness, and Screening. Kidney Int Rep. 2022;7(3):359–62. pmid:35257047
- 131. Barugahare J, Lie RK. Obligations of low income countries in ensuring equity in global health financing. BMC Med Ethics. 2015;16:59. pmid:26351245
- 132. Iheoma CG. Effect of economic uncertainty on public health expenditure in Economic Community of West African States: Implications for sustainable healthcare financing. Health Sci Rep. 2022;5(4):e678. pmid:35755411
- 133. Teerawattananon Y, Dabak SV, Khoe LC, Bayani DBS, Isaranuwatchai W. To include or not include: renal dialysis policy in the era of universal health coverage. BMJ. 2020;368:m82. pmid:31992542
- 134. Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, et al. Inequities in kidney health and kidney care. Nat Rev Nephrol. 2023;19(11):694–708. pmid:37580571
- 135. Van Biesen W, Jha V, Abu-Alfa AK, Andreoli SP, Ashuntantang G, Bernieh B, et al. Considerations on equity in management of end-stage kidney disease in low- and middle-income countries. Kidney Int Suppl (2011). 2020;10(1):e63–e71. pmid:32149010
- 136. Okpechi IG, Jha V, Cho Y, Ye F, Ijezie CI, Jindal K, et al. The case for increased peritoneal dialysis utilization in low- and lower-middle-income countries. Nephrology (Carlton). 2022;27(5):391–403. pmid:35060223
- 137. Ferguson TW, Whitlock RH, Bamforth RJ, Beaudry A, Darcel J, Di Nella M, et al. Cost-Utility of Dialysis in Canada: Hemodialysis, Peritoneal Dialysis, and Nondialysis Treatment of Kidney Failure. Kidney Med. 2021;3(1):20–30 e1. pmid:33604537
- 138. Chang YT, Hwang JS, Hung SY, Tsai MS, Wu JL, Sung JM, et al. Cost-effectiveness of hemodialysis and peritoneal dialysis: A national cohort study with 14 years follow-up and matched for comorbidities and propensity score. Sci Rep. 2016;6:30266. pmid:27461186
- 139. Howell M, Walker RC, Howard K. Cost Effectiveness of Dialysis Modalities: A Systematic Review of Economic Evaluations. Appl Health Econ Health Policy. 2019;17(3):315–30. pmid:30714086
- 140. Sharif MU, Elsayed ME, Stack AG. The global nephrology workforce: emerging threats and potential solutions! Clin Kidney J. 2016;9(1):11–22. pmid:26798456
- 141. Furia FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, et al. Developing nephrology services in low income countries: a case of Tanzania. BMC Nephrol. 2019;20(1):378. pmid:31623570
- 142. Okpechi IG, Chukwuonye II, Ekrikpo U, Noubiap JJ, Raji YR, Adeshina Y, et al. Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review. BMC Health Serv Res. 2023;23(1):446. pmid:37147670
- 143. Talbot B, Athavale A, Jha V, Gallagher M. Data Challenges in Addressing Chronic Kidney Disease in Low- and Lower-Middle-Income Countries. Kidney Int Rep. 2021;6(6):1503–12. pmid:34169191
- 144. Hole BD, Evans KM, Pyart R, Davids MR, Bedat CG, Hanafusa N, et al. International collaborative efforts to establish kidney health surveillance systems. Kidney Int. 2020;98(4):812–6. pmid:32998808
- 145. Ameh OI, Ekrikpo UE, Kengne AP. Preventing CKD in Low- and Middle-Income Countries: A Call for Urgent Action. Kidney Int Rep. 2020;5(3):255–62. pmid:32154447
- 146. Kalyesubula R, Conroy AL, Calice-Silva V, Kumar V, Onu U, Batte A, et al. Screening for Kidney Disease in Low- and Middle-Income Countries. Semin Nephrol. 2022;42(5):151315. pmid:37001337
- 147. Taylor DM, Fraser SDS, Bradley JA, Bradley C, Draper H, Metcalfe W, et al. A Systematic Review of the Prevalence and Associations of Limited Health Literacy in CKD. Clin J Am Soc Nephrol. 2017;12(7):1070–84. pmid:28487346
- 148. Jha V, Arici M, Collins AJ, Garcia-Garcia G, Hemmelgarn BR, Jafar TH, et al. Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference. Kidney Int. 2016;90(6):1164–74. pmid:27884311
- 149. Okpechi IG, Bello AK, Luyckx VA, Wearne N, Swanepoel CR, Jha V. Building optimal and sustainable kidney care in low resource settings: The role of healthcare systems. Nephrology (Carlton). 2021;26(12):948–60. pmid:34288246