Disparities in kidney failure care for children: A global survey

Abstract

Background: Globally, the capacity to access and deliver kidney replacement therapies (KRT - dialysis and transplantation) to children has never previously been described. The present study reports current disparities in access to kidney care between children and adults worldwide based on the results of the 2018 International Society of Nephrology Global Kidney Health Atlas (GKHA) survey. Methods: A mixed methods analysis of pediatric-specific data from the 2018 GKHA survey were used. Respondents were from countries categorized as low (LIC), lowermiddle (LMIC), upper-middle (UMIC) or high income (HIC) according to 2018 World Bank income classification. Descriptive statistics were used for the population-based analysis of health expenditure across different world bank countries. Open text responses were thematically analyzed using HyperRESEARCH. Results: Responses were received from 160 (88%) of 182 countries, including LIC (n=26, 16%), LMIC (n=36, 23%), UMIC (n=39, 24%) and HIC (n=59, 37%). Child access to end stage kidney disease care (ESKD) and KRT differed from adults in 29% and 23% of countries, respectively. Lower income countries were associated with graded increases in disparate access to ESKD (LIC 62%, LMIC 38%, UMIC 18%, HIC 19%) and KRT care (LIC 58%, LMIC 33%, UMIC 13%, HIC 9%). Five themes explained access disparities for children: inadequate resources for KRT; kidney failure care is expensive and incurs lifelong costs; priority and access based on a country's economic status; a lack of child-specific resources; and longer travel distances for children. Conclusions: There are significant disparities worldwide in care for children with kidney failure when compared with adults, particularly in low resource settings. Future policy and advocacy efforts are needed to promote universal, equitable kidney care for children globally.L6336970152020-12-23 <br />