Global availability of medications and health technologies for kidney care: A multinational study from the ISN-GKHA

A core feature of universal health coverage is equitable access to affordable care not exposing people to financial hardship. This study aims to provide a global overview on availability and access to medications and health technologies for delivery of optimal kidney care. An international survey of stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated to the International Society of Nephrology was conducted from July to September 2022 on availability of tools and services for all aspects of kidney care and access to essential medications. Of 167 participating countries (97.4% of the global population), there were significant disparities in kidney care funding and service availability. Only 5 (n = 1) and 10% (n = 4) of countries in Latin America and Africa, respectively, publicly funded non-dialysis CKD care free at the point of delivery, compared to73% (n = 16) in Western Europe. Public funding (and free at point of delivery) for medications for dialysis and kidney transplantation was available in only 24% (n = 39) and 30% (n = 50) of countries worldwide, with the proportion increasing in line with country income levels. There was reduced capacity for the management of CKD mineral bone disease in low-income countries (LICs) - serum parathyroid hormone was available in only 26% (n = 5) of LICs and the ability to administer non-calcium-based phosphate binders and cinacalcet was also very limited in LICs [16% (n = 3) and 5% (n = 1), respectively]. Nutritional services like oral supplements were accessible in 32% (n = 6) of LICs versus 97% (n = 61) of high-income countries. This study highlights significant gaps in the global methods of funding and availability of medications, capacity for kidney disease monitoring, and capacity to treat complications of kidney disease to improve outcomes. Achieving universal and equitable access to essential medications and health technologies for kidney care is vital to tackle the rapidly growing global burden of kidney disease.