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

Table 2 Major barriers and pragmatic solutions for acute kidney injury kidney replacement therapy in Africa

Barrier	Effect on care	Pragmatic response
Late recognition of AKI	Delayed referral and delayed KRT	Risk-based screening, urine output monitoring, point-of-care creatinine where possible
Limited dialysis infrastructure	No access to CKRT or HD in many centers	Build one dependable pathway, often acute PD or adapted emergency HD
Consumable shortages	Interrupted or incomplete treatment	Central procurement, protected stock, local supply-chain planning
Workforce shortages	Inability to deliver complex therapies safely	Multidisciplinary training for physicians, nurses, and technicians
High out-of-pocket costs	Treatment refusal, delay, early discontinuation	Public financing, emergency coverage, donor-supported start-up programs
Weak referral systems	Patients arrive with advanced complications	Standard referral criteria and transport pathways between district and tertiary centers

AKI: Acute kidney injury; CKRT: Continuous kidney replacement therapy; HD: Hemodialysis; KRT: Kidney replacement therapy; PD: Peritoneal dialysis.