Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA)

Abstract

The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.

Keywords: Africa; chronic kidney disease; kidney failure; kidney replacement therapy; nephrology workforce; out-of-pocket spending.

Figure 1

Countries in the International Society of Nephrology Africaregion.

Figure 2

Funding structures for nondialysis chronic kidney disease (CKD) and kidney replacement therapy (KRT), globally and in the International Society of Nephrology Africa region. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. AKI, acute kidney injury; HD, hemodialysis; N/A, not applicable; NGO, nongovernment organization; PD, peritoneal dialysis.

Figure 3

Country level scorecard showing availability of kidney replacement therapy (KRT), funding of medications, registries, and advocacy groups of countries in the International Society of Nephrology Africa region. Funding for medications refers to 100% publicly funded by the government (free at the point of delivery). AKI, acute kidney injury; CKD, chronic kidney disease; CKM, conservative kidney management; Dem, Democratic; HD, hemodialysis; KF, kidney failure; PD, peritoneal dialysis; PMP, per million population; Rep, Republic.

Figure 4

Availability of choice in kidney replacement therapy or conservative kidney management (CKM) for people living with kidney failure in the International Society of Nephrology Africa region. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. HD, hemodialysis; Kt/V, measure of dialysis adequacy; N/A, not applicable; PD, peritoneal dialysis; URR, urea reduction ratio.

Figure 5

Available services to diagnose and treat complications of kidney failure in the International Society of Nephrology Africa region. Values represent the absolute number of countries in each category expressed as a percentage of the total number of countries. BP, blood pressure; Hb, hemoglobin; PTH, parathyroid hormone.