Kidney Disease

Authors: John Dirks, Shuchi Anand, Bernadette Thomas, Giuseppe Remuzzi, Miguel Riella, Meguid El Nahas, Saraladevi Naicker


Reviews current data on the epidemiology and trends in the etiology of acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD), with a focus on low- and middle-income countries (LMICs), covering management of these conditions, while highlighting several interventions—treatment for AKI, screening for CKD, and modality choice for ESRD—with available data on cost or cost-effectiveness. Overall, care provision for patients with either AKI or CKD remains limited in LMICs, especially since the severe forms of each require the use of expensive renal replacement therapy (RRT). However, several current gaps can be addressed with careful policy consideration. For AKI, gathering more data on its true incidence and risk factors remains crucial. LMICs will likely face a growing burden of individuals with CKD and ESRD. Screening a high-risk, older population for CKD proves cost-effective, but identifying such a population in countries without first-level health care systems remains a key challenge. Although ESRD remains rare, large gaps remain between LMICs and high-income countries (HICs) in the provision of therapy.