Kidney replacement therapy for acute kidney injury in low-resource settings: Lessons from Africa

Acute kidney injury (AKI) is a major cause of preventable morbidity and mortality worldwide, with a disproportionate burden in low-resource settings. In these regions, AKI is commonly community-acquired, affects younger patients, and is frequently related to sepsis, hypovolemia, obstetric complications, nephrotoxins, and infections. Kidney replacement therapy (KRT) is a cornerstone of supportive care for severe AKI, but its use is strongly shaped by local infrastructure, cost, workforce, and supply chains. Current evidence does not show consistent superiority of continuous KRT, intermittent hemodialysis (IHD), prolonged intermittent KRT, or peritoneal dialysis (PD) in broad AKI populations with respect to survival or kidney recovery. Accordingly, modality choice should be individualized according to patient characteristics and local feasibility. In many African and other low-resource settings, IHD and PD remain the dominant modalities because they are more accessible and scalable than continuous therapies. This review discusses how resource limitations shape AKI KRT practice, with emphasis on Africa, and outlines pragmatic strategies to improve equitable access to life-saving renal support.