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Lunney M, Alrukhaimi M, Ashuntantang GE, Bello AK, Bellorin-Font E, Benghanem Gharbi M, Jha V, Johnson DW, Kalantar-Zadeh K, Kazancioglu R, Olah ME, Olanrewaju TO, Osman MA, Parpia Y, Perl J, Rashid HU, Rateb A, Rondeau E, Sola L, Tchokhonelidze I, Tonelli M, Wiebe N, Wirzba I, Yang CW, Ye F, Zemchenkov A, Zhao MH, Levin A. Guidelines, policies, and barriers to kidney care: findings from a global survey. Kidney Int Suppl (2011) 2018; 8:30-40. [PMID: 30675437 DOI: 10.1016/j.kisu.2017.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Gloria E Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Aminu K Bello
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Ezequiel Bellorin-Font
- Division of Nephrology and Kidney Transplantation, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India.,University of Oxford, Oxford, UK
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
| | | | - Michelle E Olah
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mohamed A Osman
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Yasin Parpia
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Ahmed Rateb
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.,Université Paris VI, Paris, France
| | - Laura Sola
- Division Epidemiologia, Direccion General de Salud-Ministerio Salud Publica, Montevideo, Uruguay
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natasha Wiebe
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Isaac Wirzba
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng Ye
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Zemchenkov
- Department of Internal Diseases and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.,Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Key Lab of Renal Disease, Ministry of Health of China, Beijing, China.,Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Wang S, Chen R, Liu Q, Shu Z, Zhan S, Li L. Prevalence, awareness and treatment of chronic kidney disease among middle-aged and elderly: The China Health and Retirement Longitudinal Study. Nephrology (Carlton) 2016; 20:474-84. [PMID: 25773384 DOI: 10.1111/nep.12449] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/31/2022]
Abstract
AIM To provide reliable estimates of the prevalence, awareness, and treatment of chronic kidney disease (CKD), and their distribution and related influencing factors in middle-aged and elderly population in China. METHODS A cross-sessional survey called the China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2011-2012 in Chinese people aged 45 years or older. This was to evaluate the prevalence of CKD, disease awareness compared to other chronic diseases in the population, and whether they were being treated for their CKD. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. CKD was defined as eGFR less than 60 mL/min per 1.73 m(2) . Multivariable logistic regressions were used to estimate odds ratios (ORs) for the risk factors. RESULTS The overall prevalence of CKD was 11.5% (95%CI: 10.1% ∼ 12.8%). It was higher in urban than rural population (13.0% vs 10.0%, P < 0.05). Among all patients with CKD, only 8.7% were aware of the diagnosis. 4.9% of the patients were receiving treatment. The proportion of those aware of their condition and those who were treated decreased with age in both sexes. Of those aware (8.9%), 55.9% were treated. 31.4% of the treated patients took Chinese traditional medicine. CONCLUSIONS There is a surprising prevalence of CKD in the Chinese middle-aged and elderly population, with disproportionately low awareness and treatment. A comprehensive strategy toward prevention, screening, treatment and control of CKD is needed to slow the epidemic of CKD.
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Affiliation(s)
- Shengfeng Wang
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ru Chen
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qing Liu
- School of Public Health, Department of Epidemiology, ScM, Brown University, Providence, Rhode Island, USA
| | - Zheng Shu
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Liming Li
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
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