Kidney replacement therapy for acute kidney injury in low-resource settings: Lessons from Africa

Table 1 Practical comparison of kidney replacement therapy modalities for acute kidney injury in low-resource settings

Modality	Main advantages	Main limitations	Best fit in low-resource settings
CKRT	Excellent hemodynamic tolerance; precise fluid control	High cost; machine dependence; intensive nursing; continuous consumables	Limited to well-resourced ICUs
IHD	Rapid correction of hyperkalemia and acidosis; familiar; can use existing chronic HD units	Needs water treatment, power, machines, vascular access, trained staff; may worsen hypotension	Stable adults in centers with functioning HD infrastructure
PIKRT	Better hemodynamic tolerance than IHD; can use standard HD machines over longer sessions	Still infrastructure-dependent; staff time intensive	Intermediate option where HD exists but CKRT is not feasible
PD	Low infrastructure requirement; no water treatment plant; useful in children and unstable patients; relatively scalable	Slower solute clearance in some settings; risk of peritonitis or leaks; requires catheter and PD expertise	Hospitals without reliable extracorporeal dialysis, pediatric AKI, remote or lower-level facilities

CKRT: Continuous kidney replacement therapy; AKI: Acute kidney injury; HD: Hemodialysis; IHD: Intermittent hemodialysis; ICU: Intensive care unit; PD: Peritoneal dialysis; PIKRT: Prolonged intermittent kidney replacement therapy.