Workforce Capacity for ESKD Care: An Analysis from the Global Kidney Health Atlas Study
Bibliographic record
Abstract
Background: Despite the rising burden of chronic kidney disease, recent surveys reveal a global shortage of nephrologists and other kidney healthcare professionals. The objective of the second iteration of the International Society of Nephrology’s (ISN) Global Kidney Health Atlas was to assess inter- and intra-national variability in the capacity for end-stage kidney disease (ESKD) care. Methods: Data were collected in two steps: desk research and a cross-sectional survey. Desk research used data from online sources, such as the Central Intelligence Agency World Factbook and the World Health Organization Global Observatory. The survey was administered online to key stakeholders worldwide, and all country-level data were analyzed by ISN region and World Bank income classification. Results: The results of desk research showed that the general healthcare workforce density varied by income level: high income countries had more healthcare workers per 10,000 population (30.30 physicians; 79.21 nursing personnel; 7.20 pharmacists; 3.47 surgeons) than low income countries (0.85 physicians; 5.02 nursing personnel; 0.10 pharmacists; 0.03 surgeons). A total of 182 countries responded to the survey, with 160 (88%) countries responding to questions pertaining to the ESKD workforce. Nephrologists were primarily responsible for providing care to ESKD patients in 92% of countries. Global nephrologist density was 9.95 per million population (pmp) and nephrology trainee density was 1.42 pmp. High income countries reported the highest densities of nephrologists and nephrology trainees (23.15 pmp and 3.83 pmp, respectively), whereas low income countries reported the lowest densities (0.24 pmp and 0.11 pmp, respectively). Compared to higher income countries, more low income countries reported shortages of all types of ESKD healthcare providers, including nephrologists, transplant surgeons, peritoneal and hemodialysis access surgeons, and peritoneal and hemodialysis access interventional radiologists. Conclusions: In this global survey, a significant trend was demonstrated in workforce capacity and distribution for ESKD care across countries. There was limited capacity in low income compared to high income countries. National and international policies are required to build a workforce that can effectively address the growing burden of ESKD.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".