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Challenges of access to kidney care for children in low-resource settings

Abstract

Kidney disease is a global public health concern across the age spectrum, including in children. However, our understanding of the true burden of kidney disease in low-resource areas is often hampered by a lack of disease awareness and access to diagnosis. Chronic kidney disease (CKD) in low-resource settings poses multiple challenges, including late diagnosis, the need for ongoing access to care and the frequent unavailability of costly therapies such as dialysis and transplantation. Moreover, children in such settings are at particular risk of acute kidney injury (AKI) owing to preventable and/or reversible causes — many children likely die from potentially reversible kidney disease because they lack access to appropriate care. Acute peritoneal dialysis (PD) is an important low-cost treatment option. Initiatives, such as the Saving Young Lives programme, to train local medical staff from low-resource areas to provide care for AKI, including acute PD, have already saved hundreds of children. Future priorities include capacity building for both educational purposes and to provide further resources for AKI management. As local knowledge and confidence increase, CKD management strategies should also develop. Increased awareness and advocacy at both the local government and international levels will be required to continue to improve the diagnosis and treatment of AKI and CKD in children worldwide.

Key points

  • Many children in low-resource settings are at risk of kidney disease, especially from common infections and preventable conditions; insufficient awareness of kidney disease and lack of access to early diagnosis are important barriers to care in low-resource settings.

  • Peritoneal dialysis (PD) using improvised catheters and fluids is a life-saving treatment for severe acute kidney injury (AKI) that can be delivered in all health economies, without electricity and by trained non-nephrologists.

  • Treatment for kidney failure is complex and expensive — the cost per disability-adjusted life year for chronic dialysis may be prohibitive in low-economy health systems — and many children with kidney disease die unnecessarily because of lack of access to dialysis and transplantation.

  • Children are less likely than adults to gain access to chronic dialysis, especially if no living kidney donor is identified, as dialysis in children is usually a bridge to transplantation and chronic dialysis services are often rationed, with priority access given to adults.

  • Kidney transplantation is more cost-effective than chronic dialysis, but may still be unaffordable and often inaccessible owing to a lack of trained personnel, infrastructure and immunosuppressive drug resources.

  • Adequate training for health-care workers must include advocacy skills to raise awareness at the community level and promote the needs of all patients with kidney disease, especially infants and children who tend to be overlooked.

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Fig. 1: Successes achieved through the MDGs that might be relevant for kidney disease.

References

  1. 1.

    Jager, K. J. et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 96, 1048–1050 (2019).

    PubMed  Google Scholar 

  2. 2.

    Mehta, R. L. et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 385, 2616–2643 (2015). This article summarized the global challenge of AKI and advocates for increased awareness, prompt treatment and more equity in access to care.

    PubMed  Google Scholar 

  3. 3.

    Macedo, E., Garcia-Garcia, G., Mehta, R. L. & Rocco, M. V. International Society of Nephrology 0 by 25 project: lessons learned. Ann. Nutr. Metab. 74 (Suppl 3), 45–50 (2019).

    CAS  PubMed  Google Scholar 

  4. 4.

    Hill, N. R. et al. Global prevalence of chronic kidney disease — a systematic review and meta-analysis. PLoS One 11, e0158765 (2016).

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Liyanage, T. et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385, 1975–1982 (2015).

    PubMed  Google Scholar 

  6. 6.

    Foreman, K. J. et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet 392, 2052–2090 (2018).

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Roser, M., Ritchie H. & Dadonaite B. Child and infant mortality. in Our World in Data https://ourworldindata.org/child-mortality (2019).

  8. 8.

    United Nations Children’s Fund. Levels & Trends in Child Mortality Report 2018 (UNICEF, 2018).

  9. 9.

    The Lancet. NCD countdown 2030: strengthening accountability. Lancet 392, 986 (2018).

    PubMed  Google Scholar 

  10. 10.

    NCD Countdown 2030 collaborators. NCD countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet 392, 1072–1088 (2018).

    Google Scholar 

  11. 11.

    Mallory, P. P. et al. Acute kidney injury, fluid overload, and outcomes in children supported with extracorporeal membrane oxygenation for a respiratory indication. ASAIO J. 66, 319–326 (2019).

    Google Scholar 

  12. 12.

    Raina, R. et al. Treatment of AKI in developing and developed countries: an international survey of pediatric dialysis modalities. PLoS One 12, e0178233 (2017). This survey highlights modalities available to treat AKI in low-resource settings.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Abdou, N. et al. Peritoneal dialysis to treat patients with acute kidney injury-the saving young lives experience in West Africa: proceedings of the saving young lives session at the first international conference of dialysis in West Africa, Dakar, Senegal, December 2015. Perit. Dial. Int. 37, 155–158 (2017).

    PubMed  Google Scholar 

  14. 14.

    Smoyer, W. E. et al. “Saving Young Lives” with acute kidney injury: the challenge of acute dialysis in low-resource settings. Kidney Int. 89, 254–256 (2016).

    PubMed  Google Scholar 

  15. 15.

    The Global Burden of Disease Child and Adolescent Health Collaboration. Child and adolescent health from 1990 to 2015: findings from the global burden of diseases, injuries, and risk factors 2015 study. JAMA Pediatr. 171, 573–592 (2017).

    PubMed Central  Google Scholar 

  16. 16.

    Institute for Health Metrics and Evaluation. GBD Compare. Healhdata https://vizhub.healthdata.org/gbd-compare (2019).

  17. 17.

    World Health Organization. Maternal mortality. World Health Organization https://www.who.int/news-room/fact-sheets/detail/maternal-mortality (2019).

  18. 18.

    Ruggajo, P. et al. Familial factors, low birth weight, and development of ESRD: a nationwide registry study. Am. J. Kidney Dis. 67, 601–608 (2016).

    PubMed  Google Scholar 

  19. 19.

    The Low Birth Weight and Nephron Number Working Group. The impact of kidney development on the life course: a consensus document for action. Nephron 136, 3–49 (2017).

    PubMed Central  Google Scholar 

  20. 20.

    Brophy, P. Maternal determinants of renal mass and function in the fetus and neonate. Semin. Fetal Neonatal Med. 22, 67–70 (2017). This article highlights the importance of early life events as risk factors for kidney disease and especially neonatal AKI.

    PubMed  Google Scholar 

  21. 21.

    Abitbol, C. L. et al. Obesity and preterm birth: additive risks in the progression of kidney disease in children. Pediatr. Nephrol. 24, 1363–1370 (2009).

    PubMed  Google Scholar 

  22. 22.

    Basu, R. K., Kaddourah, A., Goldstein, S. L. & Investigators, A. S. Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study. Lancet Child Adolesc. Health 2, 112–120 (2018).

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Charlton, J. R. et al. Late onset neonatal acute kidney injury: results from the AWAKEN Study. Pediatr. Res. 85, 339–348 (2019).

    PubMed  Google Scholar 

  24. 24.

    Abdelraheem, M. B. Acute kidney injury in low- and middle-income countries: investigations, management and prevention. Paediatr. Int. Child Health 37, 269–272 (2017).

    PubMed  Google Scholar 

  25. 25.

    Vasudevan, A., Phadke, K. & Yap, H. K. Peritoneal dialysis for the management of pediatric patients with acute kidney injury. Pediatr. Nephrol. 32, 1145–1156 (2017).

    PubMed  Google Scholar 

  26. 26.

    Perico, N., Askenazi, D., Cortinovis, M. & Remuzzi, G. Maternal and environmental risk factors for neonatal AKI and its long-term consequences. Nat. Rev. Nephrol. 14, 688–703 (2018).

    CAS  PubMed  Google Scholar 

  27. 27.

    Selewski, D. T. et al. Neonatal acute kidney injury. Pediatrics 136, e463–e473 (2015).

    PubMed  Google Scholar 

  28. 28.

    Chawanpaiboon, S. et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob. Health 7, E37–E46 (2019).

    PubMed  Google Scholar 

  29. 29.

    Lee, A. C. et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob. Health 1, e26–e36 (2013).

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Alaro, D., Bashir, A., Musoke, R. & Wanaiana, L. Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia. Afr. Health Sci. 14, 682–688 (2014).

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Kamath, N. & Luyckx, V. A. Increasing awareness of early risk of AKI in neonates. Clin. J. Am. Soc. Nephrol. 14, 172–174 (2019).

    PubMed Central  Google Scholar 

  32. 32.

    Susantitaphong, P. et al. World incidence of AKI: a meta-analysis. Clin. J. Am. Soc. Nephrol. 8, 1482–1493 (2013).

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    KDIGO Work Group. KDIGO clinical practice guideline for acute kidney injury: summary of recommendation statements. Kidney Int. Suppl. 2, 8–12 (2012).

    Google Scholar 

  34. 34.

    Olowu, W. A. et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob. Health 4, e242–e250 (2016). This systematic review highlights the spectrum of AKI and inequities in access to care for AKI in sub-Saharan Africa.

    PubMed  Google Scholar 

  35. 35.

    Mehta, R. L. et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet 387, 2017–2025 (2016).

    PubMed  Google Scholar 

  36. 36.

    Macedo, E. et al. Recognition and management of acute kidney injury in children: the ISN 0by25 Global Snapshot study. PLoS One 13, e0196586 (2018).

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Evans, R. D. R. et al. Incidence, etiology, and outcomes of community-acquired acute kidney injury in pediatric admissions in Malawi. Perit. Dial. Int. 38, 405–412 (2018).

    PubMed  Google Scholar 

  38. 38.

    Olowu, W. A. Acute kidney injury in children in Nigeria. Clin. Nephrol. 83, 70–74 (2015).

    PubMed  Google Scholar 

  39. 39.

    Aloni, M. N., Nsibu, C. N., Meeko-Mimaniye, M., Ekulu, P. M. & Bodi, J. M. Acute renal failure in Congolese children: a tertiary institution experience. Acta Paediatr. 101, e514–e518 (2012).

    PubMed  Google Scholar 

  40. 40.

    Balaka, B. et al. Etiologies et pronostic de l’insuffisance rénale de l’enfant à l’hôpital universitaire de Lomé. J. Rech. Sci. Univ. Lomé 14, 11–18 (2012).

    Google Scholar 

  41. 41.

    Luyckx, V. A. & Naicker, S. Acute kidney injury associated with the use of traditional medicines. Nat. Clin. Pract. Nephrol. 4, 664–671 (2008).

    PubMed  Google Scholar 

  42. 42.

    Stanifer, J. W. et al. Traditional medicines and kidney disease in low- and middle-income countries: opportunities and challenges. Semin. Nephrol. 37, 245–259 (2017).

    PubMed  Google Scholar 

  43. 43.

    Abdelraheem, M. et al. Outcome of acute kidney injury in Sudanese children — an experience from a sub-Saharan African unit. Perit. Dial. Int. 34, 526–533 (2014).

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Selewski, D. T. et al. The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group. Pediatr. Res. 85, 79–85 (2019).

    PubMed  Google Scholar 

  45. 45.

    Kaddourah, A., Basu, R. K., Goldstein, S. L., Sutherland, S. M. & Assessment of Worldwide Acute Kidney Injury, Renal Angina and, Epidemiology (AWARE) Investigators. Oliguria and acute kidney injury in critically ill children: implications for diagnosis and outcomes. Pediatr. Crit. Care Med. 20, 332–339 (2019).

  46. 46.

    Levin, M. et al. Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial. Lancet Respir. Med. 7, 581–593 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Muttath, A., Annayappa Venkatesh, L., Jose, J., Vasudevan, A. & Ghosh, S. Adverse outcomes due to aggressive fluid resuscitation in children: a prospective observational study. J. Pediatr. Intensive Care 8, 64–70 (2019).

    PubMed  Google Scholar 

  48. 48.

    Harambat, J. & Ekulu, P. M. Inequalities in access to pediatric ESRD care: a global health challenge. Pediatr. Nephrol. 31, 353–358 (2016). This study highlights global inequities in access to care for children with kidney failure.

    PubMed  Google Scholar 

  49. 49.

    Rees, L., Schaefer, F., Schmitt, C. P., Shroff, R. & Warady, B. A. Chronic dialysis in children and adolescents: challenges and outcomes. Lancet Child Adolesc. Health 1, 68–77 (2017).

    PubMed  Google Scholar 

  50. 50.

    Kayange, N. M. et al. Kidney disease among children in sub-Saharan Africa: systematic review. Pediatr. Res. 77, 272–281 (2015).

    PubMed  Google Scholar 

  51. 51.

    Kamath, N. & Iyengar, A. A. Chronic Kidney Disease (CKD): an observational study of etiology, severity and burden of comorbidities. Indian J. Pediatr. 84, 822–825 (2017).

    PubMed  Google Scholar 

  52. 52.

    Hari, P. et al. Chronic renal failure in children. Indian Pediatr. 40, 1035–1042 (2003).

    PubMed  Google Scholar 

  53. 53.

    Ali el, T. M., Abdelraheem, M. B., Mohamed, R. M., Hassan, E. G. & Watson, A. R. Chronic renal failure in Sudanese children: aetiology and outcomes. Pediatr. Nephrol. 24, 349–353 (2009).

    Google Scholar 

  54. 54.

    Brophy, P. D. et al. Early-life course socioeconomic factors and chronic kidney disease. Adv. Chronic Kidney Dis. 22, 16–23 (2015).

    PubMed  Google Scholar 

  55. 55.

    Mong Hiep, T. T. et al. Etiology and outcome of chronic renal failure in hospitalized children in Ho Chi Minh City, Vietnam. Pediatr. Nephrol. 23, 965–970 (2008).

    PubMed  Google Scholar 

  56. 56.

    Asinobi, A. O., Ademola, A. D., Ogunkunle, O. O. & Mott, S. A. Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria. BMC Nephrol. 15, 25 (2014).

    PubMed  PubMed Central  Google Scholar 

  57. 57.

    Satoskar, A. A., Parikh, S. V. & Nadasdy, T. Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. Nat. Rev. Nephrol. 16, 32–50 (2020).

    CAS  PubMed  Google Scholar 

  58. 58.

    Ocheke, I. E., Antwi, S., Gajjar, P., McCulloch, M. I. & Nourse, P. Pelvi-ureteric junction obstruction at Red Cross Children’s Hospital, Cape Town: a six year review. Arab J. Nephrol. Transplant. 7, 33–36 (2014).

    PubMed  Google Scholar 

  59. 59.

    Kamath, N., Iyengar, A., George, N. & Luyckx, V. A. Risk factors and rate of progression of CKD in children. Kidney Int. Rep. 4, 1472–1477 (2019).

    PubMed  PubMed Central  Google Scholar 

  60. 60.

    Soares, C. M. et al. Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program. Pediatr. Nephrol. 23, 2039–2046 (2008).

    PubMed  Google Scholar 

  61. 61.

    Ashuntantang, G. et al. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob. Health 5, e408–e417 (2017). This systematic review highlights the challenges of access to care for children with kidney failure in sub-Saharan Africa.

    PubMed  Google Scholar 

  62. 62.

    Chesnaye, N. C. et al. Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis. Lancet 389, 2128–2137 (2017). This study highlights inequities in access to care and outcomes for children in Europe.

    PubMed  Google Scholar 

  63. 63.

    International Pediatric Nephrology Association. Abstracts of the 18th Congress of the International Pediatric Nephrology Association, Venice (Italy), October 2019. Pediatr. Nephrol. 34, 1821–2260 (2019).

    Google Scholar 

  64. 64.

    Iyengar, A., Lewin, S. & Lantos, J. D. Considering family resources when making medical recommendations. Pediatrics 141, e20171198 (2018). Case illustration of ethical dilemmas facing health care practitioners when treating children with kidney failure in low-income settings.

    PubMed  Google Scholar 

  65. 65.

    Lunyera, J., Kilonzo, K., Lewington, A., Yeates, K. & Finkelstein, F. O. Acute kidney injury in low-resource settings: barriers to diagnosis, awareness, and treatment and strategies to overcome these barriers. Am. J. Kidney Dis. 67, 834–840 (2016).

    PubMed  Google Scholar 

  66. 66.

    Esezobor, C. I., Oniyangi, O. & Eke, F. Paediatric dialysis services in Nigeria: availability, distribution and challenges. West. Afr. J. Med. 31, 181–185 (2012).

    CAS  PubMed  Google Scholar 

  67. 67.

    Bello, A. K. et al. Global Kidney Health Atlas: a report by the International Society of Nephrology on the Global Burden of End-stage Kidney Disease and Capacity for Kidney Replacement Therapy and Conservative Care across World Countries and Regions. (International Society of Nephrology, Brussels, 2019).

    Google Scholar 

  68. 68.

    Luyckx, V. A., Tonelli, M. & Stanifer, J. W. The global burden of kidney disease and the sustainable development goals. Bull. World Health Organ. 96, 414–422D (2018). This article highlights the importance of achieving the sustainable development goals as a means of preventing kidney disease in children and improving access to appropriate care when needed.

    PubMed  PubMed Central  Google Scholar 

  69. 69.

    United Nations. The Millennium Development Goals Report (UN, 2015).

  70. 70.

    World Health Organization. World health statistics 2018: monitoring health for the SDGs, sustainable development goals (WHO, 2018).

  71. 71.

    The World Bank. Disease Control Priorities: Improving Health and Reducing Poverty (The World Bank, 2017).

  72. 72.

    Ware, H. The economic value of children in Asia and Africa: comparative perspectives. (East-West Center, Honolulu, Hawaii, 1978).

    Google Scholar 

  73. 73.

    Stein, D. J. et al. Investigating the psychosocial determinants of child health in Africa: the Drakenstein Child Health Study. J. Neurosci. Methods 252, 27–35 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  74. 74.

    Davidson, B., Okpechi, I., McCulloch, M. & Wearne, N. Adolescent nephrology: an emerging frontier for kidney care in sub-Saharan Africa. Nephrology 22, 933–939 (2017). This article highlights the challenges of managing adolescents with kidney disease.

    PubMed  Google Scholar 

  75. 75.

    Niang, A., Iyengar, A. & Luyckx, V. A. Hemodialysis versus peritoneal dialysis in resource-limited settings. Curr. Opin. Nephrol. Hypertens. 27, 463–471 (2018). This study compares peritoneal dialysis and haemodialysis in low-resource settings.

    PubMed  Google Scholar 

  76. 76.

    World Health Organization. Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and Universal Health Coverage. (WHO, 2014).

  77. 77.

    Teerawattananon, Y. & Russell, S. The greatest happiness of the greatest number? Policy actors’ perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand. BMC Health Serv. Res. 8, 197 (2008).

    PubMed  PubMed Central  Google Scholar 

  78. 78.

    Ploos van Amstel, S. et al. Renal replacement therapy for children throughout the world: the need for a global registry. Pediatr. Nephrol. 33, 863–871 (2018).

    PubMed  Google Scholar 

  79. 79.

    Onarheim, K. H. et al. Selling my sheep to pay for medicines — household priorities and coping strategies in a setting without universal health coverage. BMC Health Serv. Res. 18, 153 (2018).

    PubMed  Google Scholar 

  80. 80.

    Olowu, W. A. Renal failure in Nigerian children: factors limiting access to dialysis. Pediatr. Nephrol. 18, 1249–1254 (2003).

    PubMed  Google Scholar 

  81. 81.

    Defaye, F. B. et al. A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences. BMC Health Serv. Res. 15, 467 (2015).

    PubMed  PubMed Central  Google Scholar 

  82. 82.

    Callegari, J. G. et al. Peritoneal dialysis for acute kidney injury in sub-Saharan Africa: challenges faced and lessons learned at Kilimanjaro Christian Medical Centre. Kidney Int. 81, 2331–2333 (2012).

    Google Scholar 

  83. 83.

    Luyckx, V. A., Miljeteig, I., Ejigu, A. M. & Moosa, M. R. Ethical challenges in the provision of dialysis in resource-constrained environments. Semin. Nephrol. 37, 273–286 (2017).

    PubMed  Google Scholar 

  84. 84.

    Basu, S., Andrews, J., Kishore, S., Panjabi, R. & Stuckler, D. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med. 9, e1001244 (2012).

    PubMed  PubMed Central  Google Scholar 

  85. 85.

    Bello, A. K. et al. Global overview of health systems oversight and financing for kidney care. Kidney Int. Suppl. 8, 41–51 (2018).

    Google Scholar 

  86. 86.

    Bello, A. et al. The financial cost incurred by families of children on long-term dialysis. Perit. Dial. Int. 38, 14–17 (2018).

    PubMed  Google Scholar 

  87. 87.

    Francis, A. et al. The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children. Pediatr. Nephrol. 31, 1011–1019 (2016).

    PubMed  Google Scholar 

  88. 88.

    Muller, E., White, S. & Delmonico, F. Regional perspective: developing organ transplantation in sub-Saharan Africa. Transplantation 97, 975–976 (2014).

    PubMed  Google Scholar 

  89. 89.

    Miljeteig, I. & Norheim, O. F. My job is to keep him alive, but what about his brother and sister? How Indian doctors experience ethical dilemmas in neonatal medicine. Dev. World Bioeth. 6, 23–32 (2006).

    PubMed  Google Scholar 

  90. 90.

    Cullis, B. et al. Peritoneal dialysis for acute kidney injury. Perit. Dial. Int. 34, 494–517 (2014). This article contains recommendations for the use of acute peritoneal dialysis to treat AKI in children.

    CAS  PubMed  PubMed Central  Google Scholar 

  91. 91.

    Palmer, D. et al. Peritoneal dialysis for AKI in Cameroon: commercial vs locally-made solutions. Perit. Dial. Int. 38, 246–250 (2018).

    PubMed  Google Scholar 

  92. 92.

    Rope, R. et al. Expanding CAPD in low-resource settings: a distance learning approach. Perit. Dial. Int. 38, 343–348 (2018).

    PubMed  PubMed Central  Google Scholar 

  93. 93.

    Olszewski, A. E. et al. Teaching pediatric peritoneal dialysis globally through virtual simulation. Clin. J. Am. Soc. Nephrol. 13, 900–906 (2018).

    PubMed  PubMed Central  Google Scholar 

  94. 94.

    Flynn, J. T. et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140, e20171904 (2017).

    Google Scholar 

  95. 95.

    Swanepoel, C. R., Wearne, N. & Okpechi, I. G. Nephrology in Africa — not yet uhuru. Nat. Rev. Nephrol. 9, 610–622 (2013).

    PubMed  Google Scholar 

  96. 96.

    Kirwan, C. J. et al. A nurse-led intervention improves detection and management of AKI in Malawi. J. Ren. Care 42, 196–204 (2016).

    PubMed  Google Scholar 

  97. 97.

    Jenssen, G. R. et al. The incidence and aetiology of acute kidney injury in children in Norway between 1999 and 2008. Acta Paediatr. 103, 1192–1197 (2014).

    PubMed  PubMed Central  Google Scholar 

  98. 98.

    Cao, Y. et al. Etiology and outcomes of acute kidney injury in Chinese children: a prospective multicentre investigation. BMC Urol. 13, 41 (2013).

    PubMed  PubMed Central  Google Scholar 

  99. 99.

    Kaddourah, A., Basu, R. K., Bagshaw, S. M., Goldstein, S. L. & Investigators, A. Epidemiology of acute kidney injury in critically ill children and young adults. N. Engl. J. Med. 376, 11–20 (2017).

    PubMed  Google Scholar 

  100. 100.

    Harambat, J., van Stralen, K. J., Kim, J. J. & Tizard, E. J. Epidemiology of chronic kidney disease in children. Pediatr. Nephrol. 27, 363–373 (2012). This is a study discussing the epidemiology of CKD in children.

    PubMed  Google Scholar 

  101. 101.

    Olowu, W. A., Adefehinti, O. & Aladekomo, T. A. Epidemiology and clinicopathologic outcome of pediatric chronic kidney disease in Nigeria, a single cenetr study. Arab J. Nephrol. Transplant. 6, 105–113 (2013).

    PubMed  Google Scholar 

  102. 102.

    Odetunde, O. I. et al. Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria. Niger. J. Clin. Pract. 17, 196–200 (2014).

    CAS  PubMed  Google Scholar 

  103. 103.

    Soylemezoglu, O., Duzova, A., Yalcinkaya, F., Arinsoy, T. & Suleymanlar, G. Chronic renal disease in children aged 5–18 years: a population-based survey in Turkey, the CREDIT-C study. Nephrol. Dial. Transplant. 27 (Suppl 3), iii146–iii151 (2012).

    PubMed  Google Scholar 

  104. 104.

    Clark, H. et al. A future for the world’s children? A WHO-UNICEF-Lancet Commission. Lancet 395, 605–658 (2020).

    PubMed  Google Scholar 

  105. 105.

    Driollet, B. et al. Social deprivation is associated with poor kidney transplantation outcome in children. Kidney Int. 96, 769–776 (2019).

    PubMed  Google Scholar 

  106. 106.

    Montini, G. et al. Non-medical risk factors as avoidable determinants of excess mortality in children with chronic kidney disease. a prospective cohort study in Nicaragua, a model low income country. PLoS One 11, e0153963 (2016).

    PubMed  PubMed Central  Google Scholar 

  107. 107.

    Nandlal, L., Naicker, T. & Bhimma, R. Nephrotic syndrome in South African children: changing perspectives in the new millennium. Kidney Int. Rep. 4, 522–534 (2019).

    PubMed  PubMed Central  Google Scholar 

  108. 108.

    Liao, M. T. et al. Universal hepatitis B vaccination reduces childhood hepatitis B virus-associated membranous nephropathy. Pediatrics 128, e600–e604 (2011).

    PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the following organizations for co-funding the Saving Young Lives (SYL) programme: International Society of Nephrology (ISN), International Paediatric Nephrology Association (IPNA), International Society for Peritoneal Dialysis (ISPD) and Euro PD. The authors also thank Dr. David Ross (WHO) and Professor Arpana Iyengar (Paediatric Nephrologist, St. John’s National Academy of Health Sciences, Bengaluru, India) for insightful comments and suggestions on the manuscript before submission, Ariane Brusselmans and Kelly Hendricks for the coordination of ISN capacity-building activities, and Rowena Lalji (Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia) for sharing data from the Global Kidney Health Atlas.

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All authors made substantial contributions to discussions of the content and reviewed or edited the manuscript before submission. M.M., V.L. and W.E.S. wrote and researched data for the article.

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Correspondence to Mignon McCulloch.

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IPNA fellowship programme: https://ipna-online.org/programs/education/fellowship-program/

ISN fellowship programme: https://www.theisn.org/in-action/grants/fellowship/

ISPD fellowships: https://ispd.org/ispd-fellows/

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McCulloch, M., Luyckx, V.A., Cullis, B. et al. Challenges of access to kidney care for children in low-resource settings. Nat Rev Nephrol 17, 33–45 (2021). https://doi.org/10.1038/s41581-020-00338-7

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