TY - JOUR
T1 - Hemodialysis Use and Practice Patterns
T2 - An International Survey Study
AU - Htay, Htay
AU - Bello, Aminu K.
AU - Levin, Adeera
AU - Lunney, Meaghan
AU - Osman, Mohamed A.
AU - Ye, Feng
AU - Ashuntantang, Gloria E.
AU - Bellorin-Font, Ezequiel
AU - Gharbi, Mohammed Benghanem
AU - Davison, Sara N.
AU - Ghnaimat, Mohammad
AU - Harden, Paul
AU - Jha, Vivekanand
AU - Kalantar-Zadeh, Kamyar
AU - Kerr, Peter G.
AU - Klarenbach, Scott
AU - Kovesdy, Csaba P.
AU - Luyckx, Valerie A.
AU - Neuen, Brendon
AU - O'Donoghue, Donal
AU - Ossareh, Shahrzad
AU - Perl, Jeffrey
AU - Rashid, Harun Ur
AU - Rondeau, Eric
AU - See, Emily J.
AU - Saad, Syed
AU - Sola, Laura
AU - Tchokhonelidze, Irma
AU - Tesar, Vladimir
AU - Tungsanga, Kriang
AU - Kazancioglu, Rumeyza Turan
AU - Yee-Moon Wang, Angela
AU - Yang, Chih-Wei
AU - Zemchenkov, Alexander
AU - Zhao, Ming hui
AU - Jager, Kitty J.
AU - Caskey, Fergus J.
AU - Perkovic, Vlado
AU - Jindal, Kailash K.
AU - Okpechi, Ikechi G.
AU - Tonelli, Marcello
AU - Harris, David C.
AU - Johnson, David W.
PY - 2021/3
Y1 - 2021/3
N2 - Rationale & Objective: Hemodialysis (HD) is the most common form of kidney replacement therapy. This study aimed to examine the use, availability, accessibility, affordability, and quality of HD care worldwide. Study Design: A cross-sectional survey. Setting & Participants: Stakeholders (clinicians, policy makers, and consumer representatives) in 182 countries were convened by the International Society of Nephrology from July to September 2018. Outcomes: Use, availability, accessibility, affordability, and quality of HD care. Analytical Approach: Descriptive statistics. Results: Overall, representatives from 160 (88%) countries participated. Median country-specific use of maintenance HD was 298.4 (IQR, 80.5-599.4) per million population (pmp). Global median HD use among incident patients with kidney failure was 98.0 (IQR, 81.5-140.8) pmp and median number of HD centers was 4.5 (IQR, 1.2–9.9) pmp. Adequate HD services (3-4 hours 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. 32% of countries performed monitoring of patient-reported outcomes; 61%, monitoring of small-solute clearance; 60%, monitoring of bone mineral markers; 51%, monitoring of technique survival; and 60%, monitoring of patient survival. At initiation of maintenance dialysis, only 5% of countries used an arteriovenous access in almost all patients. Vascular access education was suboptimal, funding for vascular access procedures was not uniform, and copayments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs compared with patients in only 4% of high-income countries. Limitations: A cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis. Conclusions: In summary, findings reveal substantial variations in global HD use, availability, accessibility, quality, and affordability worldwide, with the lowest use evident in low- and lower-middle–income countries.
AB - Rationale & Objective: Hemodialysis (HD) is the most common form of kidney replacement therapy. This study aimed to examine the use, availability, accessibility, affordability, and quality of HD care worldwide. Study Design: A cross-sectional survey. Setting & Participants: Stakeholders (clinicians, policy makers, and consumer representatives) in 182 countries were convened by the International Society of Nephrology from July to September 2018. Outcomes: Use, availability, accessibility, affordability, and quality of HD care. Analytical Approach: Descriptive statistics. Results: Overall, representatives from 160 (88%) countries participated. Median country-specific use of maintenance HD was 298.4 (IQR, 80.5-599.4) per million population (pmp). Global median HD use among incident patients with kidney failure was 98.0 (IQR, 81.5-140.8) pmp and median number of HD centers was 4.5 (IQR, 1.2–9.9) pmp. Adequate HD services (3-4 hours 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. 32% of countries performed monitoring of patient-reported outcomes; 61%, monitoring of small-solute clearance; 60%, monitoring of bone mineral markers; 51%, monitoring of technique survival; and 60%, monitoring of patient survival. At initiation of maintenance dialysis, only 5% of countries used an arteriovenous access in almost all patients. Vascular access education was suboptimal, funding for vascular access procedures was not uniform, and copayments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs compared with patients in only 4% of high-income countries. Limitations: A cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis. Conclusions: In summary, findings reveal substantial variations in global HD use, availability, accessibility, quality, and affordability worldwide, with the lowest use evident in low- and lower-middle–income countries.
KW - end-stage kidney disease (ESKD)
KW - ESKD care
KW - funding for HD services
KW - global survey
KW - HD accessibility
KW - HD affordability
KW - HD availability
KW - health care delivery
KW - health care disparities
KW - health policy
KW - Hemodialysis (HD)
KW - international differences
KW - kidney failure
KW - quality of HD services
KW - renal replacement therapy (RRT)
KW - RRT modality
UR - http://www.scopus.com/inward/record.url?scp=85092107295&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2020.05.030
DO - 10.1053/j.ajkd.2020.05.030
M3 - Article
C2 - 32800843
AN - SCOPUS:85092107295
SN - 0272-6386
VL - 77
SP - 326-335.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -
