Survey: Conservative kidney care available in most countries, but quality varies
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Findings from the 2018 Global Kidney Health Atlas survey showed that although conservative management for kidney disease is available in most countries, the quality and accessibility of care varies.
“People with kidney failure typically receive [kidney replacement therapy] KRT in the form of dialysis or transplantation,” Meaghan Lunney, PhD student in the department of community health sciences at the University of Calgary in Canada, and colleagues wrote. “However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support.”
To document conservative kidney care practices across the globe, Lunney and colleagues reported on survey results (an ongoing initiative by the International Society of Nephrology [ISN]) and focused on “availability, accessibility and quality.” They noted that of the 160 countries that completed the survey, 154 answered questions pertaining to conservative kidney management.
General findings indicated conservative kidney management was available in 81% of the countries, though accessibility was low worldwide. In addition, 46% of countries utilized multidisciplinary teams, 32% utilized shared decision-making, 36% provided psychological, cultural or spiritual support, and 25% provided health care providers with training on conservative management delivery.
Researchers also found high-income countries reported more quality metrics than low-income countries, with no low-income countries reporting metrics for provider training.
According to Lunney and colleagues, it is important to conduct more studies on conservative management that focus on quality of life and symptom control over survival as the primary outcome measure.
Further, they suggest efforts should be placed on shared decision-making so patients receive the “most appropriate care.”
“Decision aids that inform patients about different options for treatment of kidney failure may encourage shared decision-making and help identify the most appropriate pathway,” they wrote.
The researchers added that ISN is collaborating with the WHO to develop a kidney care model for low-resource areas. The model places focus on conservative management.
“Efforts to increase the awareness, standardization and uptake of practices recommended for conservative kidney management are needed to ensure high quality of care,” the researchers wrote.
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