Abstract
Kuwait rests on the Arabian Gulf’s northwestern shore, with a total area of 17,818 km2 (1). It is a high-income country (2) with a young population (mean age of 37 in 2020) (3). However, Kuwait is plagued with high rates of diabetes, hypertension, obesity, smoking, and sedentary lifestyles (4). All are risk factors for the initiation and progression of CKD. The total population in 2020 was 4.8 million people, with 56% aged <35, 63% men, 31% Kuwaiti nationals, with 69% expatriates (foreign nationals, 67%, and Bedoons, stateless persons, 2%) (5). Expatriates have residency permits that can be renewed indefinitely. Extended residency does not guarantee citizenship. Many expatriates are men who live without their families (6). In Kuwait, hemodialysis (HD) treatments started in 1976, kidney transplantations in 1979, and peritoneal dialysis (PD) in 1982 (6). The public sector provides >90% of nephrology services, mainly from the Ministry of Health (MoH), with little contribution from the military hospital and Kuwait oil company hospital (Figure 1). Figure 1. Flow chart showing the nephrology services offered by different providers in Kuwait, and whether they are free of charge. MoH, Ministry of Health; HD, hemodialysis; PD, peritoneal dialysis; GCC, Gulf Cooperation Council. ### Public Sector #### Ministry of Health The MoH divides Kuwait into six health regions (7,8). Each region has a hospital that provides full adult nephrology services (Figure 1), including chronic PD and in-center HD, outpatient clinics (with pharmacy and intravenous therapies), vascular access procedures, and inpatient services including acute dialysis (intermittent HD or continuous renal replacement therapy), catheter insertion, plasma exchange, and urgent urological intervention. Inpatient services are free of charge for everyone in MoH hospitals. However, expatriates must pay US$30–150 for an MoH insurance card to access these services. Other applicable fees are outlined below. Kidney biopsy is conducted in all MoH hospitals and sent …
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