International Society Of Nephrology Global Kidney Health Atlas: Structures, Organization, And Services For The Management Of Kidney Failure in Newly Independent States And Russia Part 1
Mar 16, 2023
The International Society of Nephrology Global Kidney Health Atlas analyzed the current state of kidney care in Newly Independent States and Russia. Our results demonstrated that the Newly Independent States and Russia region was not an exception and showed the same effect of chronic kidney disease on health and its outcomes, facing many difficulties and challenges in terms of improving kidney care across the countries. This work summarized and presented demographics, health information systems, statistics, and national health policy of the region, as well as characteristics of the burden of chronic kidney disease and kidney failure (KF) of participating countries. Besides significant economic advancement in the region, the collected data revealed an existing shortage in KF care providers, essential medications, and health product access for KF care. Moreover, there was low reporting of kidney replacement therapy (dialysis and kidney transplantation) quality indicators and low capacity for long-term hemodialysis, peritoneal dialysis, and kidney transplantation. The financial issues and funding structures for KF care across the region needs strategic support for fundamental changes and further advancement. This article emphasizes the urgent need for further effective regional and international collaborations and partnerships for the establishment of universal healthcare systems for KF management.
The Newly Independent States (NIS) and Russian Federation, as a region, emerged after the dissolution of the Union of Soviet Socialist Republics. Following the collapse of the former Union of Soviet Socialist Republics, this region has been experiencing many socioeconomic, political, and demographic challenges, with constantly growing inequalities in access to health care and increasing diversity in the provision of medical services.1 Taking into account the historical background and its socioeconomic consequences, each country in the region is unique in terms of health care structure and policies, which has an impact on noncommunicable disease care. In this setting, chronic kidney disease (CKD) and kidney failure (KF) care remains of interest, as the strategies in disease surveillance, detection, prevention, and management vary considerably from country to country across the entire region. In this article, we leveraged data from the second iteration of the International Society of Nephrology Global Kidney Health Atlas to report on the capacity, accessibility, and quality of KF care in the NIS and Russia region. The methods for this research are described in detail elsewhere.2
Results
Results of this study are presented in tables and figures and broadly summarized into 2 categories: desk research (Tables 13–8 and 24,7,9–12 Figure 1, and Supplementary Table S1) and survey administration (Figures 2–5, Supplementary Figures S1–S5, and Supplementary Table S2).
according to relevant studies, Cistanche is a traditional Chinese herb that has been used for centuries to treat various diseases. It has been scientifically proven to possess anti-inflammatory, anti-aging, and antioxidant properties. Studies have shown that Cistanche is beneficial for patients suffering from kidney disease. The active ingredients of Cistanche are known to reduce inflammation, improve kidney function and restore impaired kidney cells. Thus, integrating Cistanche within a kidney disease treatment plan can offer great benefits to patients in managing their condition.
Cistanche helps to reduce proteinuria, lowers BUN and creatinine levels, and decreases the risk of further kidney damage. In addition, Cistanche also helps reduce cholesterol and triglyceride levels which can be dangerous to patients suffering from kidney disease.
Click To Know More About Tonify Kidney Cistanche
Ask for more:
david.deng@wecistanche.com WhatApp:86 13632399501
Setting. The NIS and Russia region is made up of 11 countries (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine, Uzbekistan, Turkmenistan, and Russian Federation) (Figure 1). The NIS and Russia region extends across entire Northern Asia and much of Eastern Europe spanning 11 time zones and incorporating a wide range of environments and landforms. It encompasses a population of >350 million with considerable diversities in economic structures, culture, environments, ethnicities, languages, population densities, religions, and living habits.
Of the 11 countries in the region: 1 is low income (per capita gross national income, #1025 US$), 3 are lower-middle income (per capita gross national income, 1026– 3995 current US$), 6 are upper-middle income (per capita gross national income, 3956–12,375 current US$), and 1 is high income (per capita gross national income, $12,376 US$). During the last 2 decades and despite socioeconomic polarization and inequality after the collapse of the Union of Soviet Socialist Republics, considerable economic growth has been evidenced in all countries of the region, according to World Bank data.3 As a proportion of gross domestic product, health expenditures ranged from 9.9% in Armenia to 3.9% in Kazakhstan, on average 6.3% in the region (Table 1).3
A brief on what is known already on the current state of kidney care in the region. A recent report on the state of kidney care in the NIS and Russia region highlighted different levels of kidney care provision, low CKD awareness, suboptimal CKD screening, delayed referrals, fragmented care, poor follow-up evaluation, and lack of country-specific data on the consequences of undiagnosed and untreated CKD and health-economic analysis in the region.4 At the same time, a growing incidence and prevalence of treated KF, a predominant dependence on hemodialysis (HD) with a slow but insufficient increase in the rate of transplantation, and little growth in the use of peritoneal dialysis (PD) were widely observed.4
Characteristics of participating countries. Fourteen respondents, representing 10 countries of the International Society of Nephrology NIS and Russia region, completed the online questionnaire (Figure 1). Most respondents were nephrologists (n ¼ 11 [79%]), followed by policymakers (n ¼ 2 [14%]) and nonphysician health professionals (n ¼ 1 [7%]), with an overall response rate of 66.7%. Participating countries represented a population of 276.8 million people. Half of all participating countries were upper-middle income (n ¼ 5 [50%]); responses also were submitted by high-income (n ¼ 1 [10%]), lower-middle-income (n ¼ 3 [30%]), and low-income (n ¼ 1 [10%]) countries (Table 1).5,6
The burden of CKD and KF in NIS and Russia. The average prevalence of CKD in the NIS and Russia region was 11.3%, which is comparable to the global average (10.0%). The lowest prevalence of CKD was in Tajikistan (7.4%), and the highest was in the Russian Federation (19.2%). The highest proportions of deaths and disability-adjusted life-years attributed to CKD were found in high-income, upper-middle-income, and lower-middle-income countries, including Uzbekistan, Armenia, Azerbaijan, and Georgia (Supplementary Table S1). About 21% of the population had obesity, ranging from 12.6% in Tajikistan to 26.6% in Belarus.13
Data on the prevalence of KF in NIS and Russia were available for only 5 of the participating countries, including Belarus, Georgia, Kazakhstan, Russian Federation, and Ukraine. The median prevalence of treated KF in NIS and Russia was 289 per million population (pmp), with the highest prevalence observed in Georgia (713 pmp) (Table 2).4,7,9 Available data on the burden of KF were sparse in NIS and Russia. Only 4 countries (Belarus, Georgia, Russian Federation, and Ukraine) had data on the prevalence and incidence of treated KF (transplantation or dialysis). The median number of new cases of treated KF in the region was lower (64.5 pmp; interquartile range [IQR], 37–203 pmp) than the global median (144 pmp), with Georgia experiencing much of this growing burden (203 pmp). The country with the highest prevalence of KF patients treated by dialysis (including both modalities: HD and PD) was Georgia, with a total of 696.9 pmp. Ukraine had the lowest prevalence of KF, with a total of 180.3 pmp (Table 2).7
Health finance and service delivery. Overall and across the region, KF care was predominantly managed by the national body (89% vs. 56% globally). In most countries, public and private systems fund nondialysis CKD: 5 countries in NIS and Russia reported that nondialysis CKD care was publicly funded, exclusively in 4 countries and with some fees at the point of care in 1 country; 2 countries (Armenia and Georgia) reported that nondialysis CKD care was funded solely on a private and out-of-pocket basis; Russia said a mix of public and private sources; and Tajikistan utilized multiple sources (government, nongovernment organizations, and communities) for funding. In 8 (88.9%) of 9 countries in the region, kidney replacement therapy (KRT; dialysis and transplantation) was funded by the government: exclusively in 6 countries (66.7%) (Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, and Uzbekistan) and with some fees at the point of care in 2 countries (22.2%) (Armenia and Ukraine) (Table 1).4,7 Thus, funding for nondialysis CKD and KRT in NIS and Russia region was significantly different when compared with equivalent global funding: services were free at the point of delivery in 44% of countries in NIS and Russia (vs. 28% globally), and KRT services were free at the point of delivery in 67% of NIS and Russia countries (Azerbaijan, Belarus, Georgia, Kazakhstan, Russian Federation, and Uzbekistan) versus 43% globally. There was no solely private funding of KRT in the NIS and Russia region.
Only 3 countries (Belarus, Georgia, and Russia) reported the annual cost of dialysis: median annual costs (in USD) per person for maintenance HD ($5876; IQR, $5070–$14,882) and maintenance PD ($10,064; IQR, $6789–$23,640) were below the global averages ($22,617 and $20,524, respectively) (Table 1).4,7,8 The costs for HD in Russia were more than twice what was estimated for Belarus and Georgia. Data on the annual cost of kidney transplantation were not available for this region.
Health workforce for nephrology care. All 9 countries reported that nephrologists were primarily responsible for KF care in NIS and Russia (n ¼ 9 [100%]), with varying support from primary care physicians in 2 countries (Georgia and Tajikistan: n ¼ 22%) and health officers and extension workers sharing the workload in 1 country (Tajikistan: n ¼ 11%) (Table 2).11 No countries in NIS and Russia reported that multidisciplinary teams were primarily responsible for KF care, compared with the 19% reported globally. The average density of nephrologists (14.4 pmp; IQR, 3.29–26.24 pmp) (no data for Uzbekistan) was higher than the median density of nephrologists globally (9.95 pmp); Tajikistan reported the lowest number of nephrologists (1.74 pmp), whereas Georgia had the highest (28.4 pmp). The median density of nephrology trainees (1.6 pmp; IQR, 0.46–3.25 pmp) in NIS and Russia was slightly above global data (1.4 pmp) (Table 2).11 The lowest density of nephrology trainees was reported by Ukraine (0.11 pmp), and the highest by Azerbaijan (49.77 pmp).
The most commonly reported workforce shortages were for dietitians (n ¼ 6 [60%]), transplant surgeons (n ¼ 5 [50%]), and interventional radiologists for HD access (n ¼ 5 [50%]) (Supplementary Figure S1). Tajikistan, a lower-middle income country, reported a shortage in all 14 types of care providers, whereas Russian Federation, a high-income country, had shortages of 9; Belarus reported a shortage for only laboratory technicians.
Essential medications and health product access for KF care. All countries in the region could provide long-term HD; data on the number of centers pmp were unavailable for Uzbekistan (Figure 3). The median number of HD centers was 3.7 pmp (n ¼ 8; IQR, 1.05–5.56 pmp), slightly lower than the global average of 4.5 centers pmp. The highest densities were reported by Georgia and Belarus (5.68 and 5.56 pmp, respectively), and the lowest by Ukraine and Tajikistan (1.05 and 0.23 pmp, respectively) (Table 2).4,7,12 Home HD was not generally available in any of the NIS and Russian countries (compared with 13% globally). Functioning vascular access was used to start dialysis in only 1% to 10% of cases in 3 countries (43%), in 11% to 50% of patients in 2 countries (29%), and in 51% to 75% of patients in 2 countries (29%). The use of tunneled catheters was lower than reported globally: only 5 (75%) of 7 countries started dialysis with tunneled catheters in 1% to 10% of cases (compared with 32% of countries globally starting with a tunneled catheter in 11%–50% cases). However, 43% of countries in the NIS and Russia region started dialysis treatment with a temporary catheter in 11% to 50% of cases. Timely surgery and vascular access education were lower in most of the countries in NIS and Russia than reported globally (Supplementary Figure S2).
All countries in NIS and Russia reported that long-term HD was available, and most had a center-based service that involved treatment 3 times per week for 3 to 4 hours. Only one country (Tajikistan) reported that HD delivery was not always 3 times per week and duration sometimes was less than 3 to 4 hours. The quality of HD delivery, in terms of treatment frequency and session duration, in the NIS and Russia region, was higher (86%) than the global average of 77% (Figure 3).
The utility of PD ranged from 4.4% in Georgia to 11.2% in Ukraine, whereas 5 countries (Armenia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) had no PD service at all (Figure 3). The median PD center density in the region was 0.41 centers pmp (n ¼ 5; IQR, 0.15–1.3 pmp), which was below the global average (1.3 centers pmp), and Kazakhstan and Armenia had the lowest PD capacity (Table 2).7,12 Three countries (27%) were able to offer an adequate frequency of exchanges (3–4 manual exchanges per day or equivalent cycles on automated PD) (Figure 3).
Figure 1 | Countries in the International Society of Nephrology (ISN) Newly Independent States (NIS) and Russia region participating in the ISN Global Kidney Health Atlas survey.
Figure 2 | Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT) care. Values represent the absolute number of countries in each category, expressed as a percentage of the total number of countries. HD, hemodialysis; N/A, not provided; NGOs, nongovernmental organizations; PD, peritoneal dialysis.
Figure 3 | Availability of choice in kidney replacement therapy or conservative kidney management for patients with kidney failure. Values represent an absolute number of countries in each category, expressed as a percentage of the total number of countries. HD, hemodialysis; Kt/V, a measure of dialysis adequacy; N/A, not provided; PD, peritoneal dialysis; URR, urea reduction ratio.
Kidney transplantation was available in all countries of the region, with a median density of 0.33 centers pmp (IQR, 0.26–0.51 pmp), lower than the global median density of 0.42 pmp (IQR, 0.20–0.72 pmp) (Table 2).7,10 Belarus had the highest capacity for kidney transplantation (0.73 pmp), whereas Tajikistan had the lowest (0.23 pmp). Of the 7 countries in the region that reported on kidney transplantation services, 4 (57%) relied on live donation (28% globally) and the other 3 (Belarus, Kazakhstan, and Russia) used a combination of live and deceased donors (72% globally). Azerbaijan and Belarus have national waitlists, Kazakhstan and Russia have regional waitlists, and 3 countries (Armenia, Georgia, and Tajikistan) do not have a waitlist for kidney transplantation (Supplementary Table S2).
Figure 4 | Accessibility of kidney replacement therapy for patients with kidney failure (KF). N/A, not provided; NIS, Newly Independent States; PD, peritoneal dialysis.
Figure 5 | Country-level scorecard for official registry in the International Society of Nephrology Newly Independent States and Russia region. AKI, acute kidney injury; CKD, chronic kidney disease.
Ask for more: david.deng@wecistanche.com WhatApp:86 13632399501
