quality care, and can increase awareness and promote advocacy around important health matters. Advocacy groups or nonprofits may urge the creation of policies, or vice versa, by demonstrating need, importance, and interest. Despite the worldwide commitment to implementing noncommunicable disease (NCD) prevention and control strategies,59 kidney disease policies often are lacking. Due to the burden of CKD and its association with other NCDs, its inclusion in these strategies may yield significant global benefits.60 1.7 National health policies thereby identifying ways to prevent or manage them. Moreover, the Agency for Healthcare Research and Quality (AHRQ) suggests that patient registries may facilitate the delivery of patientcentered care.52 Collecting data on population health statistics over time also enables programs targeted at reducing the prevalence or incidence of a specific health condition to be evaluated. Health information systems are critical tools in the management of kidney disease. Early diagnosis is important to slow progression; registries not only help primary care physicians manage people in these early stages, but also provide patients with tools to monitor and manage their health.53 Registries of people with ESKD are important mechanisms for monitoring trends in disease burden and outcomes, and for policy planning (e.g., to estimate transplantation needs and plan appropriately for organ procurement systems). Despite their importance, renal registries are lacking, particularly in lower income countries.54 Monitoring population health data may be particularly important in low and lower-middle income countries. Current status must be documented to assess the impacts of future programs and predict future resource needs. Organizational, behavioral, and economic barriers, limited access to information systems, and a lack of capacity building may impede the creation and functionality of robust health information systems in these settings.55 Future efforts to determine how to best operate these systems may be beneficial. The International Society of Nephrology (ISN) is dedicated to ensuring that all people have equitable access to sustainable kidney health. The ISN has developed several programs (www.theisn.org/programs) and initiatives (www.theisn.org/research) focused on education, training and research, and improving kidney disease awareness and detection. The ISN recognizes the global challenges associated with diagnosis and treatment of CKD, especially in low and lower-middle income countries where other challenges abound. The ISN facilitates kidney care by providing educational assistance and guidance, training caregivers, and setting up facilities. When individual countries are unable to meet targets, support can be provided to 1.8 A global ESKD strategy 26 | Introduction ISN Global Kidney Health Atlas | 2019 intergovernmental organizations through existing regional nephrology associations, e.g., AFRAN (African Association of Nephrology), SLANH (Society of Nephrology and Hypertension), and APSN (Asian Pacific Society of Nephrology). Universal health care coverage for the prevention and early management of kidney disease greatly reduces disease burden and saves lives. AKI is reversible and early treatment can prevent progression to CKD. By increasing funding for AKI detection and treatment, various affiliated bodies can help prevent progression to more severe and costly conditions. Similarly, including the targeting of associated risk factors as part of the global health agenda may result in a significant reduction of CKD worldwide. National and regional governments can play an important role in this effort by improving legislation and increasing funding for treatment of kidney diseases. Increasing access to adequate treatment for risk factors, dialysis therapies, and kidney transplantation may further contribute to a reduction in the burden of kidney disease. A better understanding of the global capacity for kidney care and how that capacity varies around the world is essential to combatting kidney disease. Knowing which policies and healthcare systems currently facilitate or impede kidney care helps set benchmarks and opportunities for improvement. Furthermore, understanding how these capacities vary across regions or countries could inform recommendations and help identify areas where knowledge or resource sharing may yield great benefits. A central goal of the ISN is its Closing the Gaps initiative (https://www.theisn.org/focus/ckd). This program provides a comprehensive strategy to address issues related to the delivery of CKD care worldwide by defining global needs and the current state of CKD care, and closing identified gaps through ISN research, education, and advocacy activities.61 GKHA is part of this Closing the Gaps initiative and focuses on documenting the current capacity of care worldwide.62 The GKHA is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. Published in 2017, the first iteration of the GKHA explored inter- and intra-national variability around the globe with respect to capacity for kidney care delivery, as defined by the WHO’s domains of health services. The 2017 GKHA demonstrated significant inter- and intra-regional variability in global kidney care, with significant gaps related to the