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Global data for monitoring the progress of nations in kidney care is limited. This study assessed alterations in crucial aspects of kidney care by analyzing data from the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) for the years 2019 (pre-pandemic) and 2023 (post-pandemic).
We leveraged 2019 and 2023 data from the ISN-GKHA and compared data on availability of kidney replacement therapy (KRT) services, access, health financing, workforce, registries, and policies. Country data were aggregated by ISN regions and World Bank income levels. Proportionate changes in the status of these measures pre- and post-pandemic were reported.
Data from 148 countries that participated in both pre- and post-pandemic surveys were available for analysis. In countries that offered public funding (free at the point of delivery), there was an increase of 3.7% for hemodialysis (HD), 21.7% for peritoneal dialysis (PD), and 16.1% for kidney transplantation (KT) services. The number of HD, PD, and KT centers increased by 9.8%, 13%, and 7.0%, respectively. Overall, access to HD and PD improved, but access to KT decreased by -3.3%. The population-based density of nephrologists globally increased from 9.5 per million population (pmp) to 12.4 pmp. Changes in the availability of kidney registries and national policies and strategies for kidney care varied across regions and income levels. Countries reported specific barriers to optimal kidney care more frequently, with an increase in geographical factors (7.3%), the availability of nephrologists (17.2%), and political factors (13%).
Significant changes were observed in critical aspects of kidney care delivery on a global scale before and after the pandemic. These changes predominantly affected the availability and access to kidney transplant services. There is a pressing need for countries and regions to implement effective strategies to ensure continued access to services, particularly kidney transplants, as part of future pandemic preparedness measures.