Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

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 ofNephrology that aims tomonitor and evaluate the status of global kidney careworldwide. 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 conservativekidneymanagement. Of these, 124 (81%) statedthat conservative kidneymanagementwas 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 inmost countries; however, it is not optimally accessible or of the highest quality.

Automated summary

The study reports on the availability, accessibility, and quality of conservative kidney management worldwide based on the 2018 Global Kidney Health Atlas survey. Despite being available in most countries, conservative kidney management still faces challenges in terms of accessibility and quality on a global scale.