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Hockham C, Ghosh A, Agarwal A, Shah K, Woodward M, Jha V. Centre-level variation in the survival of patients receiving haemodialysis in India: findings from a nationwide private haemodialysis network. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100383. [PMID: 38601176 PMCID: PMC11004392 DOI: 10.1016/j.lansea.2024.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 04/12/2024]
Abstract
Background There are no large studies examining survival in patients receiving haemodialysis in India or considering centre-level effects on survival. We measured survival variation between dialysis centres across India and evaluated the extent to which differences are explained by measured centre characteristics. Methods This is a multilevel analysis of patient survival in centres of the NephroPlus dialysis network consisting of 193 centres across India. Patients receiving haemodialysis at a centre for ≥90 days between April 2014 and June 2019 were included, with analyses restricted to centres with ≥10 such patients. The primary outcome was all-cause mortality, measured from 90 days after joining a centre. Proportional hazards models with shared frailty were used to model centre- and patient-level effects on survival. Findings Amongst 23,601 patients (median age 53 years; 29% female), the unadjusted centre-specific 180-day Kaplan-Meier survival estimates ranged between 55% (95% confidence interval [CI] 38-80%) and 100%, with a median of 88% (interquartile interval 83%-92%). After accounting for multilevel factors, estimated 180-day survival ranged between 83% (73-89%) and 97% (95-98%), with 90% 180-day survival in the average centre. The mortality rate in patients attending rural centres was 32% (Hazard Ratio 1.32; 95% CI 1.06-1.65) higher than those at urban centres in adjusted analyses. Multiple patient characteristics were associated with mortality. Interpretation This is the first national benchmark for survival amongst dialysis patients in India. Centre- and patient-level characteristics are associated with survival but there remains unexplained variation between centres. As India continues to widen dialysis access, ongoing quality improvement programs will be an important part of ensuring that patients experience the best possible outcomes at the point of care. Funding This project received no external funding.
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Affiliation(s)
- Carinna Hockham
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Arpita Ghosh
- The George Institute for Global Health, UNSW International, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Kamal Shah
- NephroPlus Dialysis Network, Hyderabad, India
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, UNSW International, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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2
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Tannor EK, Davidson B, Nlandu Y, Bagasha P, Bilchut WH, Davids MR, Diongole HM, Ekrikpo UE, Hafiz EO, Ibrahim KS, Kalyesubula R, Nalado AM, Olanrewaju TO, Onu UC, Pereira-Kamath N, Sakajiki AM, Salah M, Vincent L, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Ashuntantang GE, Arogundade FA. Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:12-28. [PMID: 38618494 PMCID: PMC11010621 DOI: 10.1016/j.kisu.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.
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Affiliation(s)
- Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bianca Davidson
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Peace Bagasha
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Directorate of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | | | - M. Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Hassane M. Diongole
- Division of Nephrology, Department of Medicine, National Hospital Zinder, Zinder, Niger
- Faculty of Health Sciences, University of Zinder, Zinder, Niger
| | - Udeme E. Ekrikpo
- Department of Medicine, University of Uyo/University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Ehab O.A. Hafiz
- Electron Microscopy Department, Clinical Laboratory Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Kwaifa Salihu Ibrahim
- Nephrology Unit, Department of Medicine, Wuse District Hospital, Abuja, Nigeria
- Department of Internal Medicine, College of Health Sciences, Nile University, Federal Capital Territory, Abuja, Nigeria
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aisha M. Nalado
- Department of Medicine, Bayero University Kano, Kano, Nigeria
| | - Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ugochi Chika Onu
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, ItukuOzalla, Enugu State, Nigeria
| | | | - Aminu Muhammad Sakajiki
- Department of Medicine, Usmanu Danfodiyo University and Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohamed Salah
- National Institute of Urology & Nephrology, Cairo, Egypt
| | | | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gloria Enow Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Fatiu Abiola Arogundade
- Renal Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Okpechi IG, Tungsanga S, Ghimire A, Johnson DW, Bello AK. Expanding the global nephrology workforce. Nat Rev Nephrol 2024; 20:151-152. [PMID: 38200139 DOI: 10.1038/s41581-024-00809-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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4
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Okpechi IG, Chukwuonye II, Ekrikpo U, Noubiap JJ, Raji YR, Adeshina Y, Ajayi S, Barday Z, Chetty M, Davidson B, Effa E, Fagbemi S, George C, Kengne AP, Jones ESW, Liman H, Makusidi M, Muhammad H, Mbah I, Ndlovu K, Ngaruiya G, Okwuonu C, Samuel-Okpechi U, Tannor EK, Ulasi I, Umar Z, Wearne N, Bello AK. Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review. BMC Health Serv Res 2023; 23:446. [PMID: 37147670 PMCID: PMC10163711 DOI: 10.1186/s12913-023-09416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. METHODS We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. RESULTS Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. CONCLUSION Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.
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Affiliation(s)
- Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Canada.
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
| | - Ijezie I Chukwuonye
- Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Udeme Ekrikpo
- Division of Nephrology, University of Uyo, Akwa Ibo State, Uyo, Nigeria
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Yemi R Raji
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Yusuf Adeshina
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Samuel Ajayi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Zunaid Barday
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Malini Chetty
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Bianca Davidson
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Effa
- Department of Medicine, University of Calabar, Calabar, Nigeria
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Stephen Fagbemi
- Department of Epidemiology, Ondo State Ministry of Health, Ondo, Nigeria
| | - Cindy George
- Non-Communicable Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Hamidu Liman
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohammad Makusidi
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Hadiza Muhammad
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ikechukwu Mbah
- Dept of Medicine College of Med and Health Sciences, Bingham University, Jos, Nigeria
| | - Kwazi Ndlovu
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | | | - Chimezie Okwuonu
- Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | | | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ifeoma Ulasi
- Department of Medicine, University of Nigeria, Ituku Ozalla, Enugu State, Nigeria
| | - Zulkifilu Umar
- Department of Epidemiology, Ondo State Ministry of Health, Ondo, Nigeria
| | - Nicola Wearne
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
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Ulasi II, Awobusuyi O, Nayak S, Ramachandran R, Musso CG, Depine SA, Aroca-Martinez G, Solarin AU, Onuigbo M, Luyckx VA, Ijoma CK. Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives. Semin Nephrol 2023; 42:151336. [PMID: 37058859 DOI: 10.1016/j.semnephrol.2023.151336] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden.
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Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; Renal Unit, Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Olugbenga Awobusuyi
- Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Saurabh Nayak
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhatinda, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Carlos G Musso
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia
| | - Santos A Depine
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Confederation of Dialysis Associations of the Argentine Republic (CADRA), Buenos Aires, Argentina
| | - Gustavo Aroca-Martinez
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia; Facultad de Ciencias de la Salud, Universidad del Norte, Barranquilla, Colombia
| | - Adaobi Uzoamaka Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA; College of Business, University of Wisconsin MBA Consortium, Eau Claire, Wisconsin, USA; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valerie A Luyckx
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Chinwuba K Ijoma
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Noubiap JJ, Effa E, Ekrikpo UE, Hamonic LN, Ashuntantang G, Bello AK, Donner JA, Figueiredo AE, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, Jha V. Early Identification of Chronic Kidney Disease – A Scoping Review of the Global Populations. Kidney Int Rep 2022; 7:1341-1353. [PMID: 35685314 PMCID: PMC9171699 DOI: 10.1016/j.ekir.2022.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. Results We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3–5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. Conclusion Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.
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7
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Okpechi IG, Jha V, Cho Y, Ye F, Ijezie CI, Jindal K, Klarenbach S, Makusidi MA, Okpechi-Samuel US, Okwuonu C, Shah N, Thompson S, Tonelli M, Johnson DW, Bello AK. The case for Increased Peritoneal Dialysis Utilization in Low- and Lower-Middle-Income Countries. Nephrology (Carlton) 2022; 27:391-403. [PMID: 35060223 DOI: 10.1111/nep.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
Peritoneal dialysis (PD) has several advantages compared to hemodialysis (HD), but there is evidence showing underutilization globally, especially in low-income and lower-middle-income countries (LLMICs) where kidney replacement therapies (KRT) are often unavailable, inaccessible, and unaffordable. Only 11% of all dialysis patients worldwide use PD, more than 50% of whom live in China, the United States of America, Mexico, or Thailand. Various barriers to increased PD utilization have been reported worldwide including patient preference, low levels of education, and lower provider reimbursement. However, unique but surmountable barriers are applicable to LLMICs including the excessively high cost of providing PD (related to PD fluids in particular), excessive cost of treatment borne by patients (relative to HD), lack of adequate PD training opportunities for doctors and nurses, low workforce availability for kidney care, and challenges related to some PD outcomes (catheter-related infections, hospitalizations, mortality, etc.). This review discusses some known barriers to PD use in LLMICs and leverages data that show a global trend in reducing rates of PD-related infections, reducing rates of modality switches from HD, and improving patient survival in PD to discuss how PD use can be increased in LLMICs. We therefore, challenge the idea that low PD use in LLMICs is unavoidable due to these barriers and instead present opportunities to improve PD utilization in LLMICs.
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India.,School of Public Health, Imperial College, London, United Kingdom.,Manipal Academy of Higher Education, Manipal, India
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Feng Ye
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chukwuonye I Ijezie
- Division of Renal Medicine, Department of Internal Medicine, Umuahia, Nigeria
| | - Kailash Jindal
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Muhammad A Makusidi
- Department of Medicine, College of Health Sciences, Usmanu Danfodiyo University, Renal Centre, Sokoto State, Nigeria
| | | | - Chimezie Okwuonu
- Division of Renal Medicine, Department of Internal Medicine, Umuahia, Nigeria
| | - Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Stephanie Thompson
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - David W Johnson
- Translational Research Institute, Brisbane, QLD, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
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