Developing nephrology programs in very low-resource settings: challenges in sustainability

Chronic kidney disease (CKD) is a worldwide public health threat and is still unrecognized by many low-income countries as a potentially devastating cause of morbidity and mortality in their population. Many other causes of morbidity and mortality compete for limited country resources both financially and for trained health personnel. Many low-income countries lack data about the rising burden of CKD. In a low-resource setting, where measures of serum creatinine may be unavailable, a simple CKD-screening program could include measures of proteinuria, but, can also include measures of CKD risk factors including blood glucose, blood pressure and body mass index. Screening programs can be coupled with both treatment and patient education programs where resources permit. Many low-income countries have no readily accessible and affordable renal replacement program so patients with ESKD die or must travel outside the country for treatment. Programs that focus both on educating nephrology health-care professionals and on prevention of CKD are necessary. Significant effort will be necessary to develop these resources and increased access to low-cost renal replacement therapy options will be important in the next decade.