METHODS: We systematically searched Pubmed for population-based studies of chronic kidney disease (CKD) and ESKD epidemiology and management. Population-level data from 23 pre-designated nations were eligible for inclusion if they pertained to people receiving dialysis or kidney transplant for ESKD. When available, government websites were utilized to identify and extract data from relevant kidney registries . Measures gathered included those related to the prevalence and mortality of ESKD; the availability of nephrologists; per capita healthcare expenditures; and use of erythropoietin stimulating agents (ESAs).
RESULTS: We obtained data from the United States (US), 7 nations in Eastern Europe, 4 each in Western Europe, Latin America, and Africa, and 3 in Asia. Documented prevalence of ESKD per million population varied from a high of 3,600 (Malaysia) to a low of 67 (Senegal). Annual mortality associated with ESKD varied from 31% (Ethiopia and Senegal) to 10% (UK). Nephrologist availability per million population varied from 40 (Japan) to <1 (South Africa) and was associated with per capita healthcare expenditures.
CONCLUSIONS: The delivery of kidney care related to ESKD varies widely among countries. Higher per capita healthcare spending is associated with increased delivery of kidney care. However, in part because documentation of kidney disease varies widely, it is difficult to determine how outcomes related to ESKD may vary across nations.
METHODS: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries.
RESULTS: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval.
CONCLUSIONS: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.