Conservative Kidney Management in the Middle East and North Africa: Attitudes, Practices, and Implementation Barriers

Conservative kidney management (CKM) is poorly developed and not easily accessible globally, especially in middle- and low-income countries. This study aimed to understand the perspectives of nephrologists on CKM and the barriers to its implementation in the Middle East and North Africa (MENA) region.

We conducted an online survey. Nephrologists were contacted through their local nephrology societies. Responses were divided into the following 3 groups as per the country's income classification by the World Bank: high-, middle-, and low-income.

A total of 336 surveys were analyzed (response rate: 34.28%). The mean age of participants was 43.3 ± 9.8 years; 50% were male, 91% practiced in urban settings, and 18% were affiliated with academic centers. Of the participants, 76% were from middle-income countries. Nearly 80% of the participants were aware of CKM, and 65% accepted CKM as a treatment modality for kidney failure. However, only 20% consistently offered CKM to their patients and only 16% had a formal CKM program at their institution. Among these, 12% had a multidisciplinary team and only 6% had formal CKM training. The major perceived barriers to CKM implementation were financial and resource constraints (37.7% and 32.7%, respectively). Cultural and religious barriers constituted 18.3% and 8.6%, respectively, and were similar among the 3 income groups.

Despite the significant awareness of CKM in the MENA region, its implementation remains poor. Key barriers include financial limitations, resource shortages, and a lack of training. Regional and national research is required to address these challenges and guide policies to improve CKM accessibility and implementation.