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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Abstract: SA-PO1051

Global Kidney Health Atlas 2019: Current Status of ESKD Care in World Countries and Regions

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Bello, Aminu K., University of Alberta, Edmonton, Alberta, Canada
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

Group or Team Name

  • * Co-Chairs, ISN Global Kidney Health Atlas on behalf of the Global Kidney Health Atlas Team

Although substantial literature describes the costs and consequences of end-stage kidney disease (ESKD), limited data are available on the capacity to deliver kidney replacement therapy (KRT) and conservative kidney management (CKM) across the world. We aimed to collect information on current global capacity (availability, accessibility, quality and affordability) to deliver KRT (dialysis and transplantation) and CKM.


A cross-sectional survey conducted from July to September 2018 by the International Society of Nephrology (ISN) across 182 countries using a purposive sample of key stakeholders identified by ISN’s national and regional leaders.


Responses were received from 160 of 182 countries (87.9%), including 317 of 460 individuals (68.9%, 2–4 respondents per country), representing 98.6% (7338.5 million of 7441.5 million) of the world’s population. Results showed wide variation in capacity and structures for KRT and CKM, funding mechanisms, health workforce, service delivery and available technologies. Information on the prevalence of treated ESKD was available in 42% (n = 91) of countries worldwide, with estimates varying >800-fold from 4 to 3392 per million population (pmp). While there was at least some reported availability of hemodialysis, peritoneal dialysis, and kidney transplantation in 100%, 76%, and 74% of countries, respectively, dialysis and kidney transplantation were accessible to >50% of patients in only 70% and 29% of countries that offer the services, respectively. CKM was available in 124 (81%) countries. Worldwide, the median rate of nephrologists was 9.96 pmp, and this varied with income level.


The analysis demonstrates significant variability worldwide in both the burden of ESKD as well as the current capacity for KRT and CKM. This includes important gaps in services and workforce. These findings have implications for policy and advocacy efforts aimed at promoting universal, equitable access to the full spectrum of ESKD care.