International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Africa

Abstract

Despite positive economic forecasts, stable democracies, and reduced regional conflicts since the turn of the century, Africa continues to be afflicted by poverty, poor infrastructure, and a massive burden of communicable diseases such as HIV, malaria, tuberculosis, and diarrheal illnesses. With the rising prevalence of chronic kidney disease and kidney failure worldwide, these factors continue to hinder the ability to provide kidney care for millions of people on the continent. The International Society of Nephrology Global Kidney Health Atlas project was established to assess the global burden of kidney disease and measure global capacity for kidney replacement therapy (dialysis and kidney transplantation). The aim of this second iteration of the International Society of Nephrology Global Kidney Health Atlas was to evaluate the availability, accessibility, affordability, and quality of kidney care worldwide. We identified several gaps regarding kidney care in Africa, chief of which are (i) severe workforce limitations, especially in terms of the number of nephrologists; (ii) low government funding for kidney care; (iii) limited availability, accessibility, reporting, and quality of provided kidney replacement therapy; and (iv) weak national strategies and advocacy for kidney disease. We also identified that within Africa, the availability and accessibility to kidney replacement therapy vary significantly, with North African countries faring far better than sub-Sahara African countries. The evidence suggests an urgent need to increase the workforce and government funding for kidney care, collect adequate information on the burden of kidney disease from African countries, and develop and implement strategies to enhance disease prevention and control across the continent.

Keywords: chronic kidney disease; dialysis; funding; kidney failure; kidney registries; workforce.

Figure 1

African countries participating in the International Society of Nephrology Global Kidney Health Atlas survey.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT) care. Values represent absolute number of countries in each category expressed as a percentage of total number of countries. HD, hemodialysis; N/A, not provided; NGOs, nongovernmental organizations; PD, peritoneal dialysis.

Figure 3

Availability of choice in kidney replacement therapy or conservative care for patients with kidney failure. Values represent absolute number of countries in each category expressed as a percentage of total number of countries. HD, hemodialysis; Kt/V, measure of dialysis adequacy; N/A, not provided; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 4

Available services to diagnose and treat complications of kidney failure. Values represent absolute number of countries in each category expressed as a percentage of total number of countries. BP, blood pressure; CA, calcium; Hb: hemoglobin; PO4, phosphate; PTH, parathyroid hormone.

Figure 5

Country-level scorecard for kidney care in Africa. AKI, acute kidney injury; CKD, chronic kidney disease; CKM, conservative kidney management; Dem. Rep., Democratic Republic; HD, hemodialysis; KF, kidney failure; KRT, kidney replacement therapy; PD, peritoneal dialysis.