Kidney disease is a significant worldwide public health problem. Acute kidney injury (AKI) and chronic kidney disease (CKD) are linked to high health care costs, poor quality of life, and serious adverse health outcomes.
Despite this burden, kidney disease is often not included in major chronic disease control strategies, presenting an obstacle when engaging with governments to address kidney diseases.
In an attempt to better define the current worldwide state of kidney care for AKI and CKD, and provide policy recommendations for improvements, the ISN launched a global survey project in 2016, the ISN-Global Kidney Health Atlas (ISN-GKHA), to collect information on the current state of readiness, capacity, and competence for kidney health care delivery in each country and region.
“A Truly Fantastic Resource”: The ISN-GKHA Leads Discuss on the Value of the Third Edition of the ISN-Global Kidney Health Atlas – Watch the Interview!
Process
The ISN-GKHA is a multinational survey conducted by the ISN to assess current capacity for kidney care. Designed to document the degree to which the six principles of the World Health Organization (WHO) Universal Health Coverage (UHC)* are available in each country or region, data is gathered on the world status of existing resources, structures, and organizations available to patients with kidney diseases.
The survey was initially administered electronically in 2016 to individuals throughout 130 countries via the ISN’s Affiliated Societies and 10 regional boards. The first global report published in 2017 highlighted kidney disease as a silent epidemic and the neglect of treatment and prevention.
A second, updated ISN-GKHA global report published in April 2019, drew attention to the growing burden of kidney diseases and the significant inequities in access to treatment across countries and regions.
The third ISN-GKHA global report published in March 2023 sheds light on current capacity around the world to deliver kidney care.
*Health Finance, Health Policy, Service Delivery and Safety, Essential Medications and Health Products, Health Information and Statistics, and Health Workforce.
The Reports
Tools and Resources
Region-specific slides
The ISN-GKHA team has prepared summary slides of the ISN-GKHA 2023 report focusing on each ISN region individually.
The ISN invites members to share the results from their region with colleagues and key stakeholders to support discussions on and advocate for kidney health care to relevant national and regional health, policy, and education officials.
A user manual, in support of the presentation slides, are available to download here in PDF format.
Eastern and Central Europe
Latin America
The Middle East
Newly Independent States and Russia
North America and the Caribbean
North and East Asia
Oceania and South East Asia
South Asia
Western Europe
Publications
First ISN GKHA issue published in 2017 (JAMA):
Bello AK, Levin A, Tonelli M, et al. Assessment of Global Kidney Health Care Status. JAMA. 2017;317(18):1864–1881. doi:10.1001/jama.2017.4046
Second issue published in 2019 (BMJ):
Bello AK, Levin A, Lunney M, et al. Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey. BMJ. 2019;367:l5873. Published 2019 Oct 31. doi:10.1136/bmj.l5873
Third issue published in 2023 (The Lancet Global Health):
Bello AK, Levin A, Okpechi IG, et al. An update on the global disparities in kidney disease burden and care across world countries and regions. The Lancet Global Health. 2019;367:l5873. Published 2024 Feb 14. doi: 10.1016/S2214-109X(23)00570-3
Main manuscript
- An update on the global disparities in kidney disease burden and care across world countries and regions. The Lancet Global Health. 2024.
UHC (Universal Health Coverage) domain names
- Global variations in funding and use of hemodialysis accesses: An international report using the ISN Global Kidney Health Atlas. BMC Nephrology 2024
- Dialysis outcomes across countries and regions: A global perspective from the ISN-GKHA. Kidney Int Report 2024.
- Organization and structures for detection and monitoring of CKD across world countries and regions: Observational data from a global survey. American Journal of Kidney Disease 2024. Article in press.
- Peritoneal Dialysis Use and Practice Patterns: An International Survey Study. American Journal of Kidney Disease 2024.
- A global overview of health system financing and available infrastructure and oversight for kidney care, Nephrology Dialysis Transplantation (NDT) 2024.
- Global structures, practices, and tools for provision of hemodialysis, Nephrology Dialysis Transplantation (NDT) 2024.
- Global structures, practices, and tools for provision of chronic peritoneal dialysis, Nephrology Dialysis Transplantation (NDT) 2024.
- Worldwide organization and structures for kidney transplantation services, Nephrology Dialysis Transplantation (NDT) 2024.
- Global access and quality of conservative kidney management, Nephrology Dialysis Transplantation (NDT) 2024.
- A global assessment of kidney care workforce, Nephrology Dialysis Transplantation (NDT) 2024.
- Global data monitoring systems and early identification for kidney diseases, Nephrology Dialysis Transplantation (NDT) 2024.
- Global kidney health priorities—perspectives from the ISN-GKHA, Nephrology Dialysis Transplantation (NDT) 2024.
UHC (Universal Health Coverage) regional papers
- Editorial: Variations in kidney care management and access: Regional assessments of the 2023 ISN-GKHA. Kidney Int Suppl. 2024
- Introduction: Update on variability in organization and structures of kidney care across world regions. Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology Africa region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology Middle East region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology NIS and Russia region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology North America and the Caribbean region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology Oceania and South East Asia region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology South Asia region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
- Capacity for the management of kidney failure in the International Society of Nephrology Western Europe region: Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024
Main manuscript
UHC (Universal Health Coverage) domain names
- Global Estimates of Capacity for Kidney Transplantation in World Countries and Regions. Transplantation. 2021 Sep
- Current status of health systems financing and oversight for end-stage kidney disease care: a cross sectional global survey. BMJ Open. 2021 July
- Workforce capacity for the care of patients with kidney failure across world countries and regions. BMJ Glob Health. 2021 Jan
- Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide. Clin J Am Soc Nephrol. 2020 Dec
- Availability, coverage, and scope of health information systems for kidney care across world countries and regions. Nephrol Dial Transplant. 2020 Dec
- Disparities in end-stage kidney disease care for children: a global survey. Kidney Int. 2020 Sep
- Peritoneal Dialysis Use and Practice Patterns: An International Survey Study. Am J Kidney Dis. 2020 Aug
- Hemodialysis Use and Practice Patterns: An International Survey Study. Am J Kidney Dis. 2020 Aug
UHC (Universal Health Coverage) regional papers
- Global variation in kidney care: national and regional differences in the care and management of patients with kidney failure. Kidney Int Suppl. 2021 Apr
- Understanding distribution and variability in care organization and services for the management of kidney care across world regions. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Africa. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Eastern and Central Europe. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in the Middle East. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Newly Independent States and Russia. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North and East Asia. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Oceania and South East Asia. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in South Asia. Kidney Int Suppl. 2021 Apr
- International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Western Europe. Kidney Int Suppl. 2021 Apr
- A roadmap for kidney care in Africa: An analysis of International Society of Nephrology–Global Kidney Health Atlas Africa data describing current gaps and opportunities. African Journal of Nephrology. 2022 Jul
Other in collaboration with KDIGO
- Availability and Affordability of Kidney Health Laboratory Tests around the Globe. Am J Nephrol. 2020 Dec
Other
- Assessing Global Kidney Nutrition Care. Clinical Journal of the American Society of Nephrology. 2022 Jan
Main manuscript
- Assessment of Global Kidney Health Care Status. JAMA. 2017
Protocol with supplements
- Global Kidney Health Atlas (GKHA): design and methods. Kidney Int Suppl (2011). 2017 Oct.
Other
- Worldwide Preparedness for Kidney Health Care. JAMA. 2017 May 9
UHC (Universal Health Coverage) domains papers
Building blocks toward sustainable kidney care around the world: results from a multinational survey by the International Society of Nephrology. Kidney Int Suppl (2011). 2018 Feb
Guidelines, policies, and barriers to kidney care: findings from a global survey. Kidney Int Suppl (2011). 2018 Feb
Global overview of health systems oversight and financing for kidney care. Kidney Int Suppl (2011). 2018 Feb
Global nephrology workforce: gaps and opportunities toward a sustainable kidney care system. Kidney Int Suppl (2011). 2018 Feb
Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project. Kidney Int Suppl (2011). 2018 Feb
Global coverage of health information systems for kidney disease: availability, challenges, and opportunities for development. Kidney Int Suppl (2011). 2018 Feb
Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology. Kidney Int Suppl (2011). 2018 Feb
Region-specific slides from the ISN-GKHA 2019
- GKHA 2019 regional slides – Africa / Slides scripts
- GKHA 2019 regional slides – Eastern and Central Europe / Slides scripts
- GKHA 2019 regional slides – Latin America / Slides scripts
- GKHA 2019 regional slides – The Middle East / Slides scripts
- GKHA 2019 regional slides – Newly Independent States and Russia / Slides scripts
- GKHA 2019 regional slides – North America and the Caribbean / Slides scripts
- GKHA 2019 regional slides – North and East Asia / Slides scripts
- GKHA 2019 regional slides – Oceania and South East Asia / Slides scripts
- GKHA 2019 regional slides – South Asia / Slides scripts
- GKHA 2019 regional slides – Western Europe / Slides scripts
The ISN-GKHA reports define the current state of kidney disease care, management, and prevention worldwide, and identify key gaps in specific areas and regions.
This information alerts local and international bodies to the initiatives and health care policies needed to improve outcomes.
Future work will include tools and strategies to address regional and national gaps over the long-term.
ISN-GKHA media coverage
Discover the impact of the ISN-GKHA through the global media coverage.
The ISN GKHA data continues to be collected and analyzed from a balanced representation of national nephrology societies, policymakers, kidney foundations, patient organizations, and advocacy groups.
New editions will be released periodically, tracking progress on the state of readiness, capacity, and competence for the delivery of kidney health care worldwide.
The next issue of the ISN GKHA will be released in 2023.
Contact
For any inquiries on the ISN GKHA, contact the ISN Research Team at research@theisn.org.