Objective To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management.
Design International cross sectional survey.
Setting International Society of Nephrology (ISN) survey of 182 countries from July to September 2018.
Participants Key stakeholders identified by ISN’s national and regional leaders.
Main outcome measures Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management.
Results Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world’s population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management—namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level.
Conclusions These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.

目的确定提供肾脏替代疗法（透析和移植）和保守肾脏管理的全球能力（可用性，可及性，质量和可负担性）。
设计国际横断面调查。
设定2018年7月至9月国际肾脏病学会（ISN）对182个国家的调查。
参与者ISN的国家和地区领导人确定了主要利益相关者。
主要结果指标国家提供肾脏替代治疗和保守肾脏管理核心要素的能力标记。
结果收到了来自182个国家中的160个（87.9％）的答复，占世界人口的97.8％（7.513亿人口中的7.385亿）。在肾脏替代治疗和保守肾脏管理的能力和结构上存在很大差异，即资金机制，卫生人力，服务提供和可用技术。在全球218个国家中，有91个（42％）提供了有关已治疗的终末期肾脏疾病患病率的信息。每百万人口的估计数从4到3392，变化了800倍以上。卢旺达是唯一报告治疗病患率数据的低收入国家。53个非洲国家中有5个（<10％）报告了这些数据。在159个国家中，有102个国家（64％）为肾脏替代治疗提供了公共资金。在159个国家中，有68个国家（43％）在提供护理时不收取任何费用，而34个国家（21％）则收取了一些费用。据报道，在156个国家中有156个（100％）可以进行血液透析，在156个国家中有119个（76％）进行了腹膜透析，在155个国家中有114个（74％）进行了肾脏移植。在提供这些服务的154个国家中，分别有108％（70％）和45（29％）的50％以上的患者可以使用透析和肾脏移植。154个国家中的124个（81％）提供了保守的肾脏管理。在全球范围内，肾脏病学家的中位数是每百万人口9.96，这随收入水平而变化。155个国家/地区中的114个（占74％）进行了肾脏移植。在提供这些服务的154个国家中，分别有108％（70％）和45（29％）的50％以上的患者可以使用透析和肾脏移植。154个国家中的124个（81％）提供了保守的肾脏管理。在全球范围内，肾脏病学家的中位数为每百万人口9.96，这随收入水平而变化。155个国家/地区中的114个（占74％）进行了肾脏移植。在提供这些服务的154个国家中，分别有108％（70％）和45（29％）的50％以上的患者可以使用透析和肾脏移植。154个国家中的124个（81％）提供了保守的肾脏管理。在全球范围内，肾脏病学家的中位数为每百万人口9.96，这随收入水平而变化。
结论这些综合数据显示了国家（包括低收入国家）为晚期肾病患者提供最佳护理的能力。他们显示出这种疾病负担的实质性差异以及肾脏替代疗法和保守肾脏管理的能力，这些都对政策产生了影响。