Atlas n Kidney registries Table A | Methods and data sources 1 Health finance and service delivery, health workforce, medicines and medical products, information systems, and governance and leadership. ESKD = end-stage kidney disease, GBD = global burden of disease, HD = hemodialysis, IDF = International Diabetes Federation, KRT = kidney replacement therapy, NCDs = non-communicable diseases, OECD = Organisation for Economic Co-operation and Development, PD = peritoneal dialysis, UHC = universal health coverage, UN = United Nations, WHF = World Heart Federation, WHO = World Health Organization peritoneal dialysis (PD), and transplantation. In addition, the GKHA summarizes the costs associated with delivering KRT and compares cost ratios of different treatment modalities across countries and regions. Moreover, it provides an overview of existing healthcare system structures for ESKD care, including: funding models for CKD and ESKD care; workforce capacity; availability and quality of KRT; health information systems; and leadership, advocacy, and barriers to optimal ESKD care. Finally, a synthesis, comparison, and analysis of country and regional data are provided to inform the efforts of policymakers, practitioners, and researchers to enhance access to and quality of care for patients with ESKD. The overall approach is summarized in Table A. ISN Global Kidney Health Atlas | 2019 Abstract | 15 A total of 160 countries (out of 182 countries contacted) responded to the survey. The countries that responded to the survey account for 98% of the world’s population. Service delivery practices, funding mechanisms, and available technologies vary widely across countries and regions. Key findings for each domain are as follows. Health finance and service delivery Nearly half of all countries (48%) provide public funding for non-dialysis CKD care, with 28% charging patients no fees and 20% charging some fees at the point of delivery. Public funding for nondialysis CKD care is more prevalent in high income countries. Low income countries report the highest use of private funding for CKD care. In total, 64% of countries provide public funding for KRT (dialysis and transplantation), with 43% charging no fees at the point of delivery and 21% charging some fees. Public funding for KRT is more prevalent in high income countries. Low income countries report the highest use of private funding for KRT. Over half of all countries provide public funding (either completely free or with some fees at the point of care delivery) for surgery to create vascular access for HD: 58% cover central venous catheter insertion, and 54% cover fistula or graft creation. Kidney transplantation surgery is publicly funded (either completely free or with some fees at the point of care delivery) in 53% of countries. Health workforce for kidney care Nephrologists are primarily responsible for ESKD in 92% of countries. Worldwide, the median number of nephrologists is 9.95 per million population (pmp). The density of nephrologists increases with income, with low income countries reporting the lowest prevalence (0.2 pmp), followed by lower-middle (1.6 pmp), upper-middle (10.8), and high (23.2 pmp) income countries. Similarly, the prevalence of nephrology trainees increases with income, with low income countries reporting the lowest prevalence (0.1 pmp), followed by lower-middle (0.6 pmp), upper-middle (1.2 pmp), and high (3.7 pmp) income countries. Over 70% of countries reported a shortage of nephrologists. Low income countries reported the greatest shortages: over 90% reported workforce shortages of nephrologists, interventional radiologists, surgeons, and transplant coordinators. Essential medicines and technologies Chronic HD services are available in all countries that completed the survey. Chronic PD and kidney transplantation services are available in 76% and 74% of countries, respectively. Availability of chronic PD and transplantation services increases with income. Only 23% of low income countries offer either chronic PD or kidney transplantation. Most countries, irrespective of income, reported the capacity to manage anemia and blood pressure. Similarly, in most countries, tests, facilities and treatments to manage electrolyte disorders and chronic metabolic acidosis are highly available, except for oral sodium bicarbonate or potassium exchange resins, which are available in just 72% and 62% of countries, respectively. The ability to manage renal bone disease varies. Most countries have the capacity to measure serum calcium and phosphorous and to administer calcium-phosphate binders. However, fewer countries have the capacity to administer noncalcium-based phosphate binders or cinacalcet. Serum parathyroid hormone measurement services are available in 65% of countries, and surgical services for parathyroidectomy are generally available in only 56% of countries. Overall, in 72% of countries with available dialysis services, at least half of patients with ESKD are able to access dialysis at the onset of kidney failure. However, access in low income countries is quite low (5%). Among countries with PD available, only 4% report PD as the initial treatment for most ESKD patients. Results 16 | Abstract ISN Global Kidney Health Atlas | 2019 Although 74% of countries offer kidney transplantation, accessibility to these services is low, particularly in lower-middle and low