Nephrology in Africa - challenges of practice in resource-limited environment

Chronic kidney disease (CKD), a major public health problem, is especially challenging for patients and healthcare personnel in Africa, a region with poor economic resources and a massive shortage of health-care workers. The burden of kidney disease is increased in poorly-resourced regions due to increased exposure to infections, poverty, poor access to healthcare, and genetic predisposition to kidney disease, contributing further to the problems when managing CKD and acute kidney injury. The vast majority of patients do not have access to renal replacement therapy. Urgent attention to cost of dialysis is required for wider expansion of services so that renal replacement therapy is affordable for the governments and populations of Africa. Priority needs to be given to prevention and treatment of acute kidney injury. Lack of resources has hampered the widespread utilization of prevention strategies; these are optimally delivered in a primary healthcare setting by doctors, nurses, and other healthcare workers with access to protocols for screening, disease management, achievement of treatment goals (with availability of therapy to retard progression), and criteria for referral to specialist and nephrology expertise. A regional or national renal registry is an important initiative to obtain accurate data on the burden of disease and outcomes of therapeutic interventions.