10 tips for providing kidney care to persons in prison

Chronic kidney disease (CKD) is prevalent in prisons and most nephrologists see persons in prison in various clinical settings. These encounters are often fraught with challenges around logistics and communication with healthcare providers staffing the prison. Preplanning clinic visits along with education for teams can improve care and ease concerns. Access to virtual consultations in prisons is variable despite it being shown to considerably improve access to care. Access to patient information material is another area for improvement, given that persons in prison are not usually allowed internet access. Another issue is handover of care when persons in prison are transferred between facilities or when they re-enter the community after release from prison. Providing care to persons in prison with established kidney failure is typically challenging, although nephrologists do provide dialysis in prisons. Data are sparse regarding access to transplantation, and the situation differs between countries, but persons in prison face challenges when accessing transplantation and posttransplant care. Palliative care for persons in prison with CKD who decide against dialysis or where dialysis seems incongruent with goals is not always available. Persons in prison are at a higher-than-average risk of CKD and nephrologists can impact outcomes by focusing on modifying these risk factors during clinical encounters. Departments and institutions should work on communication with their prisons and with structured approaches to improve renal care for this unique and vulnerable population. We suggest that nephrologists share the 10 tips with their teams and become advocates for patients with CKD in prison.