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Updated: Jun 14, 2025
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Global structures, practices, and tools for provision of hemodialysis
Htay Htay1, Yeoungjee Cho2, Vivekanand Jha3
1Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Summary
Hemodialysis (HD) care varies globally in availability, accessibility, and affordability. Lower-resourced countries face significant limitations, highlighting persistent disparities in kidney replacement therapy worldwide.
Area of Science:
- Nephrology
- Global Health
- Healthcare Systems Analysis
Background:
- Hemodialysis (HD) is the primary kidney replacement therapy globally.
- Significant disparities exist in HD care worldwide.
- This study examines global HD organizational structures, availability, accessibility, affordability, and quality.
Purpose of the Study:
- To assess the global landscape of hemodialysis (HD) care.
- To identify variations in HD availability, accessibility, affordability, and quality.
- To highlight disparities in HD services across different countries and income levels.
Main Methods:
- Cross-sectional study design.
- Utilized desk research and stakeholder surveys (clinicians, policymakers, patient advocates).
- Data collected from countries affiliated with the International Society of Nephrology (July-September 2022).
Main Results:
- 167 countries participated; in-center HD available in 98%.
- Global prevalence of HD varies significantly by region and country income.
- Home HD available in 30% of countries, primarily in Western Europe.
- Access to HD is limited for children in 19% of countries.
- HD costs range from US$4,310.2 in South Asia to US$39,825.9 in North America and the Caribbean.
Conclusions:
- Significant, long-standing variations in HD availability, access, and affordability persist globally.
- Lower-resourced countries face severe limitations in HD services.
- Addressing these disparities is crucial for equitable kidney replacement therapy.
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