BACKGROUND AND OBJECTIVES: People with kidney failure typically receive KRT in the form of dialysis or transplantation. 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. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Global Kidney Health Atlas is an ongoing initiative of the International Society of Nephrology that aims to monitor and evaluate the status of global kidney care worldwide. This study reports on findings from the 2018 Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of conservative kidney management. RESULTS: Respondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery. CONCLUSIONS: Overall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.

Australasian Kidney Trials Network University of Queensland Brisbane Queensland Australia

Centre for Transplantation and Renal Research Westmead Institute for Medical Research University of Sydney Sydney New South Wales Australia

Department of Community Health Sciences University of Calgary Calgary Alberta Canada

Department of Epidemiology and Biostatistics School of Public Health Imperial College London United Kingdom

Department of Family Medicine University of Ottawa Ottawa Ontario Canada

Department of Internal Diseases Clinical Pharmacology and Nephrology North Western State Medical University named after 1 1 Mechnikov St Petersburg Russia

Department of Medicine Faculty of Medicine King Chulalongkorn Memorial Hospital Chulalongkorn University Bangkok Thailand

Department of Medicine The University of Hong Kong Queen Mary Hospital Hong Kong Special Administrative Region China

Department of Medicine University of Calgary Calgary Alberta Canada

Department of Nephrology and Dialysis Pavlov 1st St Petersburg State Medical University St Petersburg Russia

Department of Nephrology General University Hospital Charles University Prague Czech Republic

Department of Renal Medicine Singapore General Hospital Singapore

Department of Renal Medicine St George Hospital and University of New South Wales Sydney New South Wales Australia

Dialysis Unit Centro de Asistencia del Sindicato Médico del Uruguay Institución de Asistencia Medica Privada de Profesionales Montevideo Uruguay

Division of Nephology and Hypertension Saint Louis University St Louis Missouri

Division of Nephrology and Hypertension University of Cape Town Cape Town South Africa

Division of Nephrology and Immunology Department of Medicine University of Alberta Edmonton Alberta Canada

Division of Nephrology Bezmialem Vakif University Istanbul Turkey

Division of Nephrology Department of Medicine Hasheminejad Kidney Center Iran University of Medical Sciences Tehran Iran

Division of Nephrology Department of Medicine University of British Columbia Vancouver British Columbia Canada

Division of Nephrology Faculty of Medicine Chulalongkorn University Bangkok Thailand; Bhumirajanagarindra Kidney Institute Bangkok Thailand

European Renal Association European Dialysis and Transplant Association Registry Department of Medical Informatics Academic Medical Center Amsterdam Public Health Research Institute University of Amsterdam Amsterdam The Netherlands

George Institute for Global Health University of New South Wales New Delhi India

Imperial College Renal and Transplant Centre Hammersmith Hospital London England

Intensive Care Nephrology and Transplantation Department Hopital Tenon Assistance Publique Hopitaux de Paris Paris France

Intensive Care Nephrology and Transplantation Department Hopital Tenon Assistance Publique Hopitaux de Paris Paris France and Sorbonne Université Paris France

Key Lab of Chronic Kidney Disease Prevention and Treatment Ministry of Education of China Beijing China

Key Lab of Renal Disease Ministry of Health of China Beijing China

Kidney and Hypertension Research Unit University of Cape Town Cape Town South Africa

Kidney Research Center Department of Nephrology Chang Gung Memorial Hospital Chang Gung University College of Medicine Taoyuan Taiwan

Kidney Research Center Department of Nephrology Chang Gung Memorial Hospital Linkou Taiwan

Metro South Integrated Nephrology and Transplant Services Princess Alexandra Hospital Brisbane Queensland Australia

Nephrology Development Clinical Center Tbilisi State Medical University Tbilisi Georgia

Nephrology Division Department of Internal Medicine The Specialty Hospital Amman Jordan

Pan American Health Organization World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease Cumming School of Medicine University of Calgary Calgary Alberta Canada

Peking Tsinghua Center for Life Sciences Beijing China

Prasanna School of Public Health Manipal Academy of Higher Education Manipal Karnataka India

Renal Division Department of Medicine Peking University 1st Hospital Beijing China

Richard Bright Renal Unit Southmead Hospital North Bristol National Health Service Trust Bristol United Kingdom

Translational Research Institute Brisbane Queensland Australia

UK Renal Registry Learning and Research Southmead Hospital Bristol United Kingdom and Population Health Sciences University of Bristol Bristol United Kingdom

Urinary Tract Diseases Department Faculty of Medicine and Pharmacy of Casablanca University Hassan 2 of Casablanca Casablanca Morocco

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Inequities in kidney health and kidney care