Policy Approaches to Improve Equitable Access Globally to Kidney Care

There are substantial inequities both within and between countries in the availability of kidney replacement therapy (KRT), chronic kidney disease care, and a specialized nephrology workforce. Healthcare policies are the foundation for optimal population health and quality health care. In this article, we present 5 country case studies to illustrate how Thailand, Uruguay, India, South Africa, and the United States have made progress in reducing kidney health inequities through healthcare policy change. Lessons learned from these case studies include the importance of 1) universal KRT coverage, 2) access to care across the spectrum of kidney care, 3) investments in public health and reducing adverse social determinants of health, 4) systematic approaches such as health technology assessments to inform policy decisions given finite resources, and 5) prioritizing noncommunicable diseases. The international community can learn from individual country strategies to close policy gaps relating to kidney disease and create momentum toward improving kidney health for all.