The second Global Kidney Health Summit outputs: developing a strategic plan to increase access to integrated end-stage kidney disease care worldwide

The articles in this edition of Kidney International Supplements describe the background, rationale, and action plans for developing a strategic approach to increase access to integrated end-stage kidney disease (ESKD) care worldwide over the next decade. It is estimated that the number of people dying globally with ESKD for want of kidney replacement therapy is up to 3 times the number who receive it.¹ Kidney transplantation meets only a small fraction of this therapeutic need. Many patients with advanced kidney disease, whether receiving kidney replacement therapy or not, suffer considerably because they have no access to supportive care. Finally, about 188 million people experience catastrophic health expenditure annually as a result of kidney diseases across low- and middle-income countries, the greatest of any disease group.² The vision of the International Society of Nephrology (ISN) is to work toward removing inequities so that all patients requiring kidney replacement therapy and/or supportive care have access to affordable integrated ESKD care.

The ISN convened the 2nd Global Kidney Health Summit in Sharjah, United Arab Emirates, in March 2018. Ninety-two individuals with diverse expertise and professional backgrounds (including administrators, clinicians, clinical and translational researchers, epidemiologists, industry scientists, nurses, nurse practitioners, pediatric nephrologists, an ethicist, a health economist, a patient, and a World Health Organization representative) from 41 countries around the globe met to discuss the challenges involved in improving worldwide access to integrated ESKD care. The primary paper of the Summit was published in Kidney International in April 2019.³ The Summit was supported by unrestricted educational grants from 2 industry partners and the ISN.

This edition of Kidney International Supplements presents a more in-depth description of eight Summit working groups. Pecoits-Filho and colleagues discuss the reasons for global differences in ESKD treatment and outcomes, and present strategies for gathering robust health information to guide resource allocation, service planning, policy development, and outcome monitoring.⁴ A survey was conducted by Luyckx and Pecoits-Filho to gather globally representative data on dialysis funding, eligibility, procurement, and monitoring, and assembled 88 clinical protocols.⁵ Tonelli et al. and Yang and colleagues describe a framework for establishing and developing integrated programs that address all aspects of kidney care, including ESKD,⁶ and go on to present a series of 15 case studies documenting context-driven variability in approaches to kidney care while demonstrating the potential advantages of multi-stakeholder engagement.⁷ Increasing the number and expertise of trained nurses, technicians, and doctors is needed to tackle the needs for kidney care at all stages from prevention and detection to ESKD care, as shown by Swanepoel et al.⁸ Sola and colleagues argue for the importance of robust standards of care, standardized evidence-based guidelines, and organized oversight mechanisms to address substantial heterogeneity in practice patterns, standards, and outcomes.⁹ Van Biesen and others examine the prevalent inequities in ESKD treatment provision around the world through an economic lens and discuss the need for focusing on availability, affordability, and acceptability in providing care.¹⁰ Luyckx et al. discuss ethical dilemmas of ESKD through the 4 core ethical principles of harm/benefit balance, social justice, respect of autonomy, and the need for transparency, at the level of individual patients, the community, and policy.¹¹ With respect to transplantation, O’Connell et al. emphasize the crucial role of appropriate legislation, community engagement, and adequate investment, especially in a highly skilled workforce, as the key elements for service development.¹² Finally, Hole and colleagues describe the main gaps, opportunities, and challenges in delivering supportive care for patients receiving kidney replacement therapy or conservative treatment.¹³

Each article attempts to include perspectives from around the globe, and to represent the current state of knowledge as well as critically evaluate the gaps and offer concrete suggestions to address those gaps. ISN looks forward to the development of a cohesive strategy for ESKD care over the next year, and its successful implementation over the next decade in partnership with the World Health Organization, national and regional societies, patient groups, and all members of the worldwide kidney community.

Disclosure

Publication of this article was supported by the International Society of Nephrology.

DCHH reports grant support from National Health and Medical Research Council. SJD reports grant support from Baxter Health Care (Clinical Evidence Council and Extramural Research Grants). VJ reports consulting or paid advisory board fees from Baxter Healthcare, Zydus Cadilla, and NephroPlus and grant support from Baxter Healthcare, GSK, Department of Biotechnology (India), UK Medical Research Council, and Indian Council of Medical Research. FOF reports consulting fees from Baxter, AstraZeneca, and GSK, and research support from the Renal Research Institute.