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

Table 3 Strategic priorities for strengthening acute kidney injury care in Africa

Priority	Current challenge	Recommended action	Expected impact
Early AKI recognition	Delayed diagnosis and referral	Implement AKI risk assessment, urine output monitoring, and point-of-care creatinine testing	Earlier diagnosis and reduced disease severity at presentation
Standardized referral pathways	Delayed access to nephrology services	Develop national referral algorithms linking district and tertiary hospitals	Faster initiation of appropriate KRT
Expansion of acute PD programs	Limited access to extracorporeal KRT	Scale up acute PD services, particularly in secondary and rural hospitals	Increased KRT availability and reduced preventable mortality
Adaptation of existing HD infrastructure	Limited CKRT availability	Optimize emergency use of chronic HD units and SLED where feasible	Improved access to life-saving dialysis
Workforce development	Shortage of nephrologists and dialysis personnel	Expand multidisciplinary education for physicians, nurses, and technicians	Safer and more sustainable AKI care
Affordable access to dialysis consumables	Frequent treatment interruption due to supply shortages	Strengthen procurement systems and encourage local manufacturing	Improved continuity of dialysis services
National AKI registries	Limited epidemiological and outcome data	Establish multicenter African AKI registries	Better quality improvement and health policy planning
African pragmatic clinical trials	Limited region-specific evidence	Conduct implementation-focused multicenter trials evaluating context-adapted AKI care pathways	Generation of evidence directly applicable to African healthcare systems
Government commitment and financing	High out-of-pocket expenditure	Integrate AKI care into national health strategies and universal health coverage	Improved equity and long-term sustainability of AKI care

AKI: Acute kidney injury; CKRT: Continuous kidney replacement therapy; HD: Hemodialysis; KRT: Kidney replacement therapy; PD: Peritoneal dialysis; PIKRT: Prolonged intermittent kidney replacement therapy; SLED: Sustained low-efficiency dialysis.