kidney health workforce, health service delivery, essential medicines and technologies, health financing, leadership and governance, health information systems, strategies and policy frameworks, and research capacity and development, particularly in low and middle income countries. These findings provided the foundation for a global CKD surveillance and benchmarking network. Prevention of ESKD and improving access to care is a significant focus of the ISN (https://www.theisn.org/focus/eskd-focus); its programs are designed to improve understandings of ESKD and its determinants, highlight the necessary standards of ESKD care, and enhance the ability to treat ESKD in resource-constrained settings. This second iteration of the GKHA survey is aimed at defining the current global status of the structures and organization of ESKD care. It focuses on the capacity and readiness of nations to achieve universal access to equitable integrated ESKD care, including KRT and conservative care. By understanding and potentially helping to shape relevant health policies, practices, and infrastructure, the ISN aims to facilitate the implementation of equitable and ethical care for kidney patients in all regions and countries of the world. The ISN’s Closing the Gaps initiative provides a comprehensive strategy for CKD care worldwide. ISN Global Kidney Health Atlas | 2019 Methods | 27 This iteration of the GKHA is the product of collaborative efforts with regional and national project leaders. Two key methods were used to produce the atlas: a desk research component, which involved searching literature and other data sources to calculate estimates; and a key opinion leader survey, whereby three leaders from each country (a nephrology society leader, a leader of a consumer representative organization, and a policymaker) submitted details on national kidney care capacity and practices with a specific focus on KRT. Assistance from international contacts, collaborators, ISN leaders, and regional board members was sought to facilitate both approaches during the development of the GKHA. Project leaders at the regional and national levels ensured the inclusion of local nephrology association leaders, consumer representatives, policymakers, and other opinion leaders across regions and countries. Project leaders organized and followed up on responses for all countries within a specific world region; played a liaison role between the steering committee, ISN, and regional stakeholders; helped gain access to additional data sources and contacts for surveys; identified or served as opinion leaders on the project for each specific world region; and identified or served as resource persons to vet and review regional data. SECTION 2 METHODS 2.1 Overview This report pertains to 218 countries recognized by the World Bank and specifically focuses on countries with ISN affiliate societies. Regional boards for the 10 ISN regions coordinated the work performed in each of the countries. Each region’s work was led by a steering committee and working group within the stipulated timeline (Figure 2.1). The 10 ISN regions are: 1. Africa 2. Eastern & Central Europe 3. Latin America & the Caribbean* 4. Middle East 5. North America & the Caribbean* 6. North & East Asia 7. Oceania & South East Asia 8. Newly Independent States & Russia 9. South Asia 10. Western Europe 2.2 Scope and timeline * Within the ISN, the islands of the Caribbean are affiliated with either North America & the Caribbean or Latin America & the Caribbean (see Appendix Table A2.1). For simplicity, the main body of the Atlas refers to these regions as North America and Latin America. Desk research efforts included a review of published scientific literature, government reports, and other relevant data sources on the various aspects of ESKD epidemiology and health system characteristics corresponding to each of the WHO universal health coverage (UHC) domains (i.e., service delivery, health workforce, information systems, medicines and medical products, financing, and leadership) (Tables 2.1 and 2.2). Although published literature is important to consider, much of the available evidence was expected to be found in gray literature, including websites and reports with limited circulation. The national and regional project leaders helped identify these sources and conducted a detailed gray literature search by following a strategy designed by an expert research librarian. To gather information on current kidney care practices and the burden and costs of ESKD, three literature reviews were performed: 1. A broad literature review of national health system characteristics associated with each of the WHO UHC domains with an emphasis on important elements relevant to the organization and delivery of ESKD care. 2. A systematic review of relevant ESKD epidemiology data on disease burden and outcomes across countries and regions, including: ® Prevalence and incidence of overall ESKD (treated); ® Dialysis (HD and PD) incidence and prevalence; ® HD incidence and prevalence; ® PD incidence and prevalence; ® Kidney transplantation incidence and prevalence; ® Kidney transplantation by donor type (living or deceased). 2.3 Desk research 28 | Methods ISN Global Kidney Health Atlas | 2019 Figure 2.1 | Timeline of the GKHA project Dec 2017 Jan 2018 Feb 2018 Mar 2018 Apr 2018 May 2018 Jun 2018 Jul