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Original ArticlesGeriatric and Palliative Nephrology
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Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

Meaghan Lunney, Aminu K. Bello, Adeera Levin, Helen Tam-Tham, Chandra Thomas, Mohamed A. Osman, Feng Ye, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Mohammad Ghnaimat, Htay Htay, Yeoungjee Cho, Vivekanand Jha, Shahrzad Ossareh, Eric Rondeau, Laura Sola, Irma Tchokhonelidze, Vladimir Tesar, Kriang Tungsanga, Rumeyza Turan Kazancioglu, Angela Yee-Moon Wang, Chih-Wei Yang, Alexander Zemchenkov, Ming-hui Zhao, Kitty J. Jager, Kailash K. Jindal, Ikechi G. Okpechi, Edwina A. Brown, Mark Brown, Marcello Tonelli, David C. Harris, David W. Johnson, Fergus J. Caskey and Sara N. Davison
CJASN January 2021, 16 (1) 79-87; DOI: https://doi.org/10.2215/CJN.09070620
Meaghan Lunney
1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Aminu K. Bello
2Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Adeera Levin
3Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Helen Tam-Tham
4Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chandra Thomas
4Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mohamed A. Osman
5Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Feng Ye
2Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ezequiel Bellorin-Font
6Division of Nephology and Hypertension, Saint Louis University, St. Louis, Missouri
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Mohammed Benghanem Gharbi
7Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
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Mohammad Ghnaimat
8Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
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Htay Htay
9Department of Renal Medicine, Singapore General Hospital, Singapore
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Yeoungjee Cho
10Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
11Translational Research Institute, Brisbane, Queensland, Australia
12Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Vivekanand Jha
13George Institute for Global Health, University of New South Wales, New Delhi, India
14Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
15Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Shahrzad Ossareh
16Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
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Eric Rondeau
17Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
18Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France and Sorbonne Université, Paris, France
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Laura Sola
19Dialysis Unit, Centro de Asistencia del Sindicato Médico del Uruguay - Institución de Asistencia Medica Privada de Profesionales (CASMU-IAMPP), Montevideo, Uruguay
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Irma Tchokhonelidze
20Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
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Vladimir Tesar
21Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
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Kriang Tungsanga
22Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
23Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
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Rumeyza Turan Kazancioglu
24Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
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Angela Yee-Moon Wang
25Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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Chih-Wei Yang
26Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
27Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Alexander Zemchenkov
28Department of Internal Diseases, Clinical Pharmacology, and Nephrology, North-Western State Medical University named after I. I. Mechnikov, St. Petersburg, Russia
29Department of Nephrology and Dialysis, Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
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Ming-hui Zhao
30Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
31Key Lab of Renal Disease, Ministry of Health of China, Beijing, China
32Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
33Peking-Tsinghua Center for Life Sciences, Beijing, China
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Kitty J. Jager
34European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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Kailash K. Jindal
2Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ikechi G. Okpechi
35Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
36Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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Edwina A. Brown
37Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, England
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Mark Brown
38Department of Renal Medicine, St George Hospital and University of New South Wales, Sydney, New South Wales, Australia
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Marcello Tonelli
4Department of Medicine, University of Calgary, Calgary, Alberta, Canada
39Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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David C. Harris
40Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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David W. Johnson
10Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
11Translational Research Institute, Brisbane, Queensland, Australia
12Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Fergus J. Caskey
41UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, United Kingdom and Population Health Sciences, University of Bristol, Bristol, United Kingdom
42Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, United Kingdom
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Sara N. Davison
2Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract

Background and objectives People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality.

Design, setting, participants, & measurements The Global Kidney Health Atlas is an ongoing initiative of the International Society of Nephrology that aims to monitor and evaluate the status of global kidney care worldwide. This study reports on findings from the 2018 Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of conservative kidney management.

Results Respondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery.

Conclusions Overall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.

  • kidney failure
  • conservative kidney management
  • global health
  • survey
  • capacity
  • Received June 8, 2020.
  • Accepted October 28, 2020.
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (1)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 1
January 07, 2021
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Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide
Meaghan Lunney, Aminu K. Bello, Adeera Levin, Helen Tam-Tham, Chandra Thomas, Mohamed A. Osman, Feng Ye, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Mohammad Ghnaimat, Htay Htay, Yeoungjee Cho, Vivekanand Jha, Shahrzad Ossareh, Eric Rondeau, Laura Sola, Irma Tchokhonelidze, Vladimir Tesar, Kriang Tungsanga, Rumeyza Turan Kazancioglu, Angela Yee-Moon Wang, Chih-Wei Yang, Alexander Zemchenkov, Ming-hui Zhao, Kitty J. Jager, Kailash K. Jindal, Ikechi G. Okpechi, Edwina A. Brown, Mark Brown, Marcello Tonelli, David C. Harris, David W. Johnson, Fergus J. Caskey, Sara N. Davison
CJASN Jan 2021, 16 (1) 79-87; DOI: 10.2215/CJN.09070620

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Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide
Meaghan Lunney, Aminu K. Bello, Adeera Levin, Helen Tam-Tham, Chandra Thomas, Mohamed A. Osman, Feng Ye, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Mohammad Ghnaimat, Htay Htay, Yeoungjee Cho, Vivekanand Jha, Shahrzad Ossareh, Eric Rondeau, Laura Sola, Irma Tchokhonelidze, Vladimir Tesar, Kriang Tungsanga, Rumeyza Turan Kazancioglu, Angela Yee-Moon Wang, Chih-Wei Yang, Alexander Zemchenkov, Ming-hui Zhao, Kitty J. Jager, Kailash K. Jindal, Ikechi G. Okpechi, Edwina A. Brown, Mark Brown, Marcello Tonelli, David C. Harris, David W. Johnson, Fergus J. Caskey, Sara N. Davison
CJASN Jan 2021, 16 (1) 79-87; DOI: 10.2215/CJN.09070620
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