Dialysis Care around the World: A Global Perspectives Series
Timmy Lee, Jennifer E. Flythe, Michael Allon
Abstract
Worldwide, ESKD prevalence per million population (PMP) has steadily increased from 2003 to 2016 (1), with the greatest proportional increases occurring in lower- and middle-income countries (2). Although dialysis is a lifesaving therapy, it is also extraordinarily expensive, so its use is limited in lower-income countries with less resources available for healthcare. Specifically, the prevalence of dialysis in 2010 was 1176 PMP in higher-income countries, 688 PMP in upper-middle-income countries, 170 PMP in lower-income countries, and 16 PMP in lower-income countries (2). The most common modality of kidney replacement therapy globally is dialysis (78%) and, among patients receiving dialysis, only 11% receive peritoneal dialysis (3). The Kidney360 Global Dialysis Perspective series launched in 2020 and showcases how dialysis is practiced, delivered, and financed in different countries across the world. To date, we have featured perspectives from 17 countries in six continents: Africa (Senegal, South Africa), Asia (India, Israel, Japan, Korea, Singapore, Thailand, Vietnam), Australia, Europe (Spain), North America (Canada, Mexico, United States), and South America (Argentina, Brazil, Guatemala) (4⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓–20). Authors of each global perspective were asked to report standard information about their dialysis populations, including general characteristics of the dialysis system and its treatments, such as percentage of patients by dialysis modality, dialysis-unit financing (for profit versus nonprofit), reimbursement (public or private insurance, or self-pay), unit location (hospital versus freestanding), staffing (proportion of nurses versus patient-care technicians and nurse/patient ratios), hemodialysis frequency and session length, and frequency of nephrologist visits. Authors also discussed key challenges and needs unique to their countries, with many discussing potential strategies to improve care moving forward. These perspectives provide fascinating insights about dialysis care in individual countries. Although the availability of dialysis correlates roughly with a country's …