A global study of the burden of kidney disease released during the International Society of Nephrology meeting here suggests that by the year 2030, 14.5 million people will have ESKD worldwide.
Recent estimates by researchers predict more than 1.2 million of those patients will be treated in the United States by that date.
However data from the Global Kidney Health Atlas (GKHA), which covers 160 countries, indicates that 5.4 million of those patients will not receive treatment due to economic, social and political factors. More than 2 million people die every year worldwide because of little or no access to dialysis or kidney transplantation, according to researchers.
The prevalence count means that 0.1% of the world’s population has ESKD, with the highest incidence in low-income countries (up to seven times higher compared to high-income countries). However, 4% of populations living in low-income countries have access to dialysis or transplantation compared to 60% in high-income countries, the GKHA data show.
Geographic barriers are high in Africa (78%), Latin America (78%), North and East Asia (57%), OSEA countries (80%) and South Asia (100%). Geographic barriers are less prevalent in Eastern and Central Europe (32%), the Middle East (18%), NIS and Russia (29%), North America (33%) and Western Europe (15%), according to the report.
Barriers due to limited availability of nephrologists are most prevalent in South Asia (100% of countries), Africa (83%), OSEA countries (80%) and Latin America (78%). Nephrologist availability is a barrier in more than half of the countries in NIS and Russia (57%) and the Middle East (55%), and in a significant proportion of countries in North America (44%), North and East Asia (43%) and Eastern and Central Europe (32%).
The top barriers to optimal ESKD care identified in the report are:
- economic factors (reported by 64% of countries);
- patient knowledge or attitude (in 63% of countries);
- availability of kidney specialists (in 60% of countries);
- other physician availability, access, knowledge and/or attitude (in 58% of countries);
- distance from care or prolonged travel time (in 55% of countries); and
- availability, access and capacity of the health care system (in 55% of countries).
The Atlas researchers proposed solutions that included:
- increased health care financing for ESKD prevention and management;
- address workforce shortages by developing effective multidisciplinary teams, task shifting (eg, allowing primary care practitioners to play a greater role in treatment) and harnessing the potential of telemedicine;
- develop and implement context-specific surveillance systems based on available capacity and resources;
- promote ESKD prevention and treatment by implementing policies, incorporating CKD into global non-communicable disease strategies, supporting advocacy groups and mitigating barriers to care;
- promote low intervention, PD as the initial mode of treatment and remove barriers to practical, cost-effective supplies of PD solutions;
- support the development of innovative, cost-effective dialysis methodologies;
- develop appropriate legislative and policy frameworks to support kidney transplantation in all countries; and
- increase access to conservative care delivery where appropriate.
The 2019 Atlas can be downloaded at www.theisn.org/global-atlas.