income countries. Among countries with kidney transplantation available, 64% of high income countries reported high access to care for most patients, compared to 30% of upper-middle, 13% of lower-middle, and 0% of low income countries. Quality indicators for HD and PD are similarly measured and reported. Blood pressure is measured and reported most of the time (HD: 86%; PD: 85%), as is hemoglobin (HD: 88%; PD: 84%). Patient survival and bone mineral markers for both HD and PD patients are measured and reported in approximately 70% of countries. Technique survival is routinely measured and reported for HD patients in 51% of countries and for PD patients in 61% of countries. Small solute clearance and patient-reported outcome measures (PROMS) are only measured and reported in approximately 60% and 30% of countries, respectively. More countries measure and report quality indicators for kidney transplant recipients. Conservative care is delivered in 81% of countries surveyed. The availability of conservative care does not appear to be associated with income level. However, access to chosen or medicallyadvised conservative care increases with country income level: 87% of high income countries offer chosen conservative care, compared to 64% of upper-middle, 43% of lower-middle and 33% of low income countries. The provision of nonmedical components of conservative care such as psychological, cultural, and spiritual support for patients receiving conservative care also increases with country income, but remains low, being provided in just 52% of high, 30% of uppermiddle, 31% of lower-middle, and 19% of low income countries. Health information systems Only 13 AKI registries and 19 non-dialysis CKD registries exist. Among the countries surveyed, 66% have dialysis registries (59% of which require provider participation) and 57% have transplantation registries (65% of which require provider participation). Irrespective of income level, most countries screen people with hypertension, diabetes, or urological conditions for CKD. Chronic users of nephrotoxic medications, people with a family history of CKD, and high-risk ethnic groups are screened for CKD in few countries, regardless of country income level. Screening of patients with cardiovascular diseases, autoimmune or multisystem disorders, or those over 65 years of age is less common, and increases with country income level. Leadership and governance Overall, 73 (46%) countries have current national strategies for NCDs, and 21 (13%) countries have strategies under development. National strategies for improving CKD care exist in 69 (43%) countries. Among these, 32 (20%) are standalone strategies for CKD care and 37 (23%) are incorporated in general NCD management strategies. Overall, 53 (33%) countries have CKD-specific policies. No low income countries have policies, whereas 29% of lower-middle, 29% of upper-middle, and 55% of high income countries have policies. Worldwide, AKI, CKD, and ESKD are recognized by governments as health priorities in only 13%, 51%, and 58% of countries, respectively. Governments of high and upper-middle income countries tend to recognize CKD and ESKD as health priorities more often. Similarly, there are few advocacy groups for AKI, CKD, and ESKD; they exist in only 14%, 63%, and 39% of countries worldwide. Both CKD and ESKD advocacy groups are more common in high, upper-middle, and lower-middle income countries than in low income countries. The top barriers to optimal ESKD care are: economic factors (64% of countries), patient knowledge or attitude (63%); nephrologist availability (60%); physician availability, access, knowledge, and/or attitude (58%); distance from care or prolonged travel time (55%); and availability, access, and capability of the healthcare system (55%). ISN Global Kidney Health Atlas | 2019 Abstract | 17 This second iteration of the GKHA focuses specifically on ESKD care. The survey results demonstrate significant inter- and intra-regional variability in current capacity to deliver ESKD care. Important gaps exist in the availability and affordability of services, workforce capacity, characteristics of ESKD care delivery, adoption of health information systems, and strategies and policies for CKD and ESKD care. The findings have implications for the development of policies to promote optimal ESKD care delivery. Specifically, efforts should be directed toward preventing ESKD by providing affordable and appropriate AKI and CKD care. Detection programs targeted at high-risk individuals are needed, particularly for AKI. Increasing universal health coverage for medications in early-stage CKD is important to slow disease progression and prevent the need for costly ESKD therapies. Promoting PD and conservative care as treatment options in situations where HD may not be appropriate or too expensive may enable optimal and feasible ESKD care. Overall, ESKD treatment strategies are complex, as they involve multiple key health system factors; characteristics of local contexts, such as competing priorities and resource limitations, must be considered. The aim of the GKHA initiative is to summarize the current global state of ESKD care. By sharing these findings, we hope to guide policy and advocacy efforts to promote optimal and universal ESKD care, and to provide