Kidney Health for All – Bridging the gap to better kidney care in Africa

Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from  epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low  transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. Conclusion: Africa needs greater investment in kidney health

Risk Factors, Epidemiology and Outcome of Acute Kidney Injury among Pediatric Admissions in a Primary Health Facility in Cameroon

Background and aim: Little is known about what happens in primary health structures without nephrology care, especially in the paediatric population. We sought describe the epidemiology of AKI in children at risk in district hospitals in Cameroon. Methods: We prospectively screened consenting children aged 2-18 years of age in paediatric wards of 3 large urban district hospitals over a period of 4 months. Participants with AKI were then followed up till discharge. Outcomes of interest were need and access to dialysis, and renal recovery on hospital discharge. Written assent was obtained from parents or caregivers. Results: Among the 211 children admitted during the study period, 82% (n=173) were at risk of AKI, of whom 19 (11%) did not consent. Of the 154 children included 54.5% were males and the median age was 6 years [IQ 3-10]. Sepsis and volume depletion were the most common risk factors of AKI. The incidence of AKI was 12.3% (n=19). AKI was mostly community acquired and 47.4% (n=9) patients were in KDIGO stage 3. Pre-renal AKI and acute tubular necrosis accounted for 63.2% and 36.8% respectively. Gastro-intestinal losses, malaria, bacterial sepsis and nephrotoxins were the common aetiologies of AKI. On discharge, 71.7% of AKI had complete recovery renal function. Conclusion: Risk factors of AKI are very common in children on admission in general district hospitals in Cameroon. Efforts should be made to raise awareness of primary health caregivers about risk assessment, prevention, early recognition and management of AKI in children

Access to nephrology care for pregnancy-related acute kidney injury in Low- and lower-middle-income countries: A perspective

Pregnancy-related acute kidney injury (AKI) is a major public health problem with substantial maternal and fetal morbidity and mortality. Women with pregnancy-related AKI require immediate access to nephrology care to prevent deleterious kidney and health outcomes. Patients with pregnancy-related AKI in low-income and lower-middle-income countries experience disparities in access to comprehensive nephrology care for many reasons. In this perspective, we highlight the burden of pregnancy-related AKI and explore the challenges among different low-income and lower-middle-income countries. The lack of adequate nephrology workforce and infrastructure for kidney health care represents a fundamental component of the problem. A shortage of nephrologists hampers the care of patients with pregnancy-related AKI leading to poor outcomes. The lack of diagnostic tools and therapeutic options, including kidney replacement therapy, impedes the implementation of effective management strategies. International efforts are warranted to empower women to get the right services and support at the right time. Dedicated preventive and early care programs are urgently needed to decrease the magnitude of pregnancy-related AKI, a complication under-represented in the literatur

Néphrologie solidaire : la coopération Genève-Yaoundé

La maladie rénale chronique (MRC) a une haute prévalence au Cameroun et va devenir un important problème de santé publique. Sa prise en charge doit être globale, partant de la prévention de la MRC jusqu’à la mise en place des techniques de suppléance extrarénale les plus adaptées aux besoins des patients et aux ressources disponibles localement. Des actions concrètes, dans le cadre d’une néphrologie solidaire, impliquant des services de néphrologie d’Afrique et d’Europe, peuvent y contribuer. La collaboration entre les Hôpitaux universitaires de Genève et ceux de Yaoundé en est un exemple probant, avec la mise en place d’un essai clinique sur le traitement de l’acidose métabolique liée à la MRC, une aide à la pose des cathéters de dialyse par sonographie et l’initiation d’un programme de transplantation rénale avec des donneurs vivants.Chronic kidney disease (CKD) has a high prevalence in Cameroon and will become an important public health problem. Its management must be comprehensive, starting with CKD prevention to the implementation of renal replacement therapies best suited to the needs of patients and resources available in Cameroon. Practical interventions involving nephrology departments in both Africa and Europe can contribute to an improved management of CKD in Africa. The current collaboration between the Geneva University Hospitals and the Yaoundé teaching hospitals is a convincing example. It includes a clinical trial on the treatment of metabolic acidosis linked to CKD, assistance with the placement of hemodialysis catheters by sonography and the initiation of a kidney transplantation program with living donors