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Hemodialysis Use and Practice Patterns: An International Survey Study
Htay Htay1, Aminu K Bello2, Adeera Levin3
1Department of Renal Medicine, Singapore General Hospital, Singapore.
Insights
Global hemodialysis (HD) use and quality vary significantly, with lower-income nations facing greater challenges in access and affordability for this vital kidney replacement therapy.
Area of Science:
- Nephrology
- Public Health
- Global Health Equity
Background:
- Hemodialysis (HD) is the predominant form of kidney replacement therapy worldwide.
- Significant disparities in HD care access and quality are suspected globally.
Purpose of the Study:
- To comprehensively assess the global landscape of hemodialysis care.
- Examining use, availability, accessibility, affordability, and quality of HD services across diverse economic settings.
Main Methods:
- A global cross-sectional survey was conducted.
- International Society of Nephrology convened stakeholders from 182 countries in 2018.
- Descriptive statistics were employed to analyze collected data.
Main Results:
- HD use varied widely, with lower rates in low-income countries.
- Adequate HD services were available in only 27% of low-income countries.
- Significant financial barriers and suboptimal vascular access practices were noted, particularly in lower-income nations.
Conclusions:
- Substantial global disparities exist in hemodialysis utilization, availability, accessibility, quality, and affordability.
- Low- and lower-middle-income countries face the most significant challenges in HD care provision.
Rationale & Objective:
Hemodialysis (HD) is the most common form of kidney replacement therapy. This study aimed to examine the use, availability, accessibility, affordability, and quality of HD care worldwide.
Study Design:
A cross-sectional survey.
Setting & Participants:
Stakeholders (clinicians, policy makers, and consumer representatives) in 182 countries were convened by the International Society of Nephrology from July to September 2018.
Outcomes:
Use, availability, accessibility, affordability, and quality of HD care.
Analytical Approach:
Descriptive statistics.
Results:
Overall, representatives from 160 (88%) countries participated. Median country-specific use of maintenance HD was 298.4 (IQR, 80.5-599.4) per million population (pmp). Global median HD use among incident patients with kidney failure was 98.0 (IQR, 81.5-140.8) pmp and median number of HD centers was 4.5 (IQR, 1.2-9.9) pmp. Adequate HD services (3-4 hours 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. 32% of countries performed monitoring of patient-reported outcomes; 61%, monitoring of small-solute clearance; 60%, monitoring of bone mineral markers; 51%, monitoring of technique survival; and 60%, monitoring of patient survival. At initiation of maintenance dialysis, only 5% of countries used an arteriovenous access in almost all patients. Vascular access education was suboptimal, funding for vascular access procedures was not uniform, and copayments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs compared with patients in only 4% of high-income countries.
Limitations:
A cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis.
Conclusions:
In summary, findings reveal substantial variations in global HD use, availability, accessibility, quality, and affordability worldwide, with the lowest use evident in low- and lower-middle-income countries.
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