Health care disparities

Survey Identifies Gaps in Kidney Nutrition Care Worldwide

Significant nutrition care gaps exist in service capacity, availability, affordability, and interdisciplinary communication worldwide for patients with kidney disease, according to the results of a recent survey.

Because nutrition care is an important element in the management of kidney disease, 2 international groups collaborated to assess the worldwide availability of nutrition services and oral nutrition supplements for patients with kidney disease by using an extended electronic survey to develop the International Society of Nephrology (ISN) Global Kidney Health Atlas. From July 2018 through September 2018, the International Society of Renal Nutrition and Metabolism partnered with the ISN Global Kidney Health Atlas Committee to administer the survey to key kidney care stakeholders in 182 countries affiliated with the ISN. Stakeholders responded to the survey in 160 of the 182 (88%) ISN-affiliated countries, and stakeholders in 97% (155) of these 160 countries responded to the survey questions specific to kidney nutrition care.

Their responses revealed that about half (48%) of the 155 countries whose stakeholders responded to the survey questions specific to kidney nutrition care have dietitians that provide kidney nutrition care service. Furthermore, dietary counseling by a provider trained in nutrition generally was not available in 65% of low-income or lower-middle–income countries and was never available in nearly one‑quarter (23%) of low-income countries.

Formal assessment of nutrition status was not provided in 41% of the 155 countries, and oral nutrition supplements generally were not freely available to either inpatients or outpatients in low-income or lower-middle–income countries. Moreover, dietitians and nephrologists only communicated “sometimes” regarding kidney nutrition care in 60% of the 155 countries.

“This survey reveals significant gaps in global kidney nutrition care service capacity availability, [and] cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries,” the survey administrators concluded.


—Ellen Kurek



Yee-Moon Wang A, Okpechi IG, Ye F, et al. Assessing global kidney nutrition care. Clin J Am Soc Nephrol. 2022;17(1):38-52. doi:/10.2215/CJN.07800621