National strategies for addressing chronic kidney disease (CKD) are crucial to improving kidney health. We sought to describe country-level variations in non-communicable disease (NCD) strategies and CKD-specific policies across different regions and income levels worldwide. The International Society of Nephrology Global Kidney Health Atlas (GKHA) was a multinational cross-sectional survey conducted between July and October 2018. Responses from key opinion leaders in each country regarding national NCD strategies, the presence and scope of CKD-specific policies, and government recognition of CKD as a health priority were described overall and according to region and income level. 160 countries participated in the GKHA survey, comprising 97.8% of the world's population. Seventy-four (47%) countries had an established national NCD strategy, and 53 (34%) countries reported the existence of CKD-specific policies, with substantial variation across regions and income levels. Where CKD-specific policies existed, non-dialysis CKD care was variably addressed. 79 (51%) countries identified government recognition of CKD as a health priority. Low- and low-middle income countries were less likely to have strategies and policies for addressing CKD and have governments which recognise it as a health priority. The existence of CKD-specific policies, and a national NCD strategy more broadly, varied substantially across different regions around the world but was overall suboptimal, with major discrepancies between the burden of CKD in many countries and governmental recognition of CKD as a health priority. Greater recognition of CKD within national health policy is critical to improving kidney healthcare globally.

Centre for Kidney Disease Research University of Queensland Brisbane Australia

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

Department of Community Health Sciences University of Calgary Calgary Canada

Department of Intensive Care Austin Health Melbourne Australia

Department of Internal Disease and Nephrology North Western State Medical University named after 1 I Mechnikov Saint Petersburg Russia

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

Department of Medicine Monash University Melbourne Australia

Department of Medicine Queen Mary Hospital The University of Hong Kong Pok Fu Lam Hong Kong

Department of Medicine University of Calgary Calgary Canada

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

Department of Nephrology General University Hospital Charles University Prague Czech Republic

Department of Nephrology Kidney Foundation Hospital and Research Institute Dhaka Bangladesh

Department of Paediatrics and Child Health University of Cape Town Cape Town South Africa

Department of Renal Medicine Royal North Shore Hospital Sydney Australia

Dialysis Unit CASMU IAMPP Montevideo Uruguay

Division of Nephology and Hypertension Department of Medicine Saint Louis University Saint Louis Missouri United States of America

Division of Nephrology and Hypertension University of California Irvine Medical Center Orange California United States of America

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 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 Canada

Division of Nephrology Department of Medicine University of Toronto Toronto Canada

Division of Nephrology St Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute St Michael's Hospital Toronto Canada

ERA Registry Department of Medical Informatics Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam Amsterdam The Netherlands

Faculty of Medicine and Biomedical Sciences Yaounde General Hospital University of Yaounde Yaounde Cameroon

George Institute for Global Health India New Delhi India

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

Manipal Academy of Higher Education Manipal India

Metro South and Ipswich Nephrology and Transplant Services Princess Alexandra Hospital Brisbane Australia

Nephrology Development Clinical Center Tbilisi State Medical University Tbilisi Georgia

Nephrology Division Department of Internal Medicine The Specialty Hospital Amman Jordan

Oxford Kidney Unit Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom

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

Peking Tsinghua Center for Life Sciences Beijing China

Population Health Sciences University of Bristol Bristol United Kingdom

Renal Division Brigham and Women's Hospital Harvard Medical School Boston Massachusetts United States of America

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

School of Medicine University of Melbourne Melbourne Australia

School of Public Health Imperial College London United Kingdom

Sorbonne Université Paris France

The George Institute for Global Health University of New South Wales Sydney Australia

The Richard Bright Renal Unit Southmead Hospital North Bristol NHS Trust Bristol United Kingdom

Translational Research Institute Brisbane Australia

University of Leicester Leicester United Kingdom

University of Tennessee Health Science Center Memphis Tennessee United States of America

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

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