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Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world's population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.

Objective: The extent to which different oscillometric blood pressure (BP) algorithms differ in how they derive BP in patients with chronic kidney disease (CKD) is unknown. We compared the performance of three different oscillometric algorithms against a known oscillometric reference standard in this patient population. Methods: Thirty intermittent hemodialysis (HD) patients and 30 stage 3 CKD (CKD) patients were recruited from a quaternary care, academic hospital in Edmonton, Canada. In random order, three sequential readings with an Omron HEM 907XL device and three sequential readings with a laptop-driven oscillometric device capable of detecting and recording oscillometric waveforms were obtained 30 seconds apart. The mean of each three reading set was used for analyses. Oscillometric algorithms (two fixed-ratio and one slope- based) were applied to the raw oscillometric data to derive BP. Paired t-tests were used to assess for statistical significance at the 0.05 level. Results: Mean age was 63.4 ± 16.3 y (HD group) and 65.9 ± 10.7 y (CKD group); percent female was 37% (HD) and 47% (CKD); mean BMI was 28.3 kg/m 2 (HD) and 30.3 kg/m 2 (CKD). Over 80% of participants in each group had hypertension. BP comparisons are summarized in Table 1. Conclusions: Varying the type of oscillometric algorithm results in markedly different systolic BP estimates in patients with CKD. The fixed-ratio algorithm produced results most comparable to the Omron device. These findings help clarify why different devices using different algorithms produce different results in patients with CKD.