The Future of Kidney Care in Low and Middle-Income Countries: Challenges, Triumphs and Opportunities.

Abstract

Chronic kidney disease (CKD) affects about 850 million people worldwide and is projected to be the fifth leading cause of death by 2040. Individuals from low- and middle-income countries (LMICs) bear the bulk of CKD. They face challenges including lack of awareness among the general population as well as health care providers, unique risk factors such as genetic predispositions, infectious diseases and environmental toxins, limited availability and affordability of diagnostic tests, medications and limited access to kidney replacement therapies. The inadequate health system infrastructure, human resources, and financing mechanisms to support comprehensive and integrated kidney care worsens the situation. Overcoming these challenges needs concerted efforts towards early detection, intervention and multidisciplinary follow up, policy, collaboration, advocacy and financing. To achieve this, there is need for individual governments to include kidney health among the key health priorities and build capacity towards resilient health care systems. Integrating kidney care using the roadmaps of well-established management systems for other chronic diseases such as HIV has the potential to expedite the widespread adoption of kidney health. This article aims to provide an overview of the current state and future prospects of kidney care in LMICs, highlighting the main challenges, ongoing efforts, and opportunities for improvement. We present case studies of exemplary efforts from three continents of the world with the highest densities of LMICs and propose potential strategies for a sustainable solution.