Venezuela is going through a humanitarian crisis that has severely impacted all programmes of kidney replacement therapy — dialysis coverage has decreased markedly, particularly in small towns and rural areas, and almost all peritoneal dialysis and deceased donor organ procurement for kidney transplantation have been discontinued.
Humanitarian challenges in Nephrology
This series of articles focuses on global humanitarian challenges in nephrology that contribute to widespread disparities in kidney health, including issues related to social injustices and environmental protection. These articles explore areas of progress and highlight where innovation in research and policy are most needed to tackle health inequity.
The COVID-19 pandemic and the Movement for Black Lives have focused attention on racial disparities in kidney health outcomes. In 2020, kidney professionals highlighted threats posed by racism and other negative social drivers of kidney health, and proposed solutions to address these issues through scholarship and advocacy for social justice.
The nephrology community is increasingly being confronted with the challenge of caring for refugees with kidney disease. An urgent need exists for a global registry of these patients as well as consistent guidance for financial, cultural and ethical issues in order to ensure that they receive sustainable and equitable care.
Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease.
Many children die from preventable and/or treatable kidney disease in low-resource settings. Here, the authors examine strategies to improve the care of these children, including the need to invest in disease prevention and early detection, promote disease awareness and education, and adapt treatments to expand provision.
Chronic kidney disease (CKD) is a rapidly growing public health problem, especially in disadvantaged populations. Major political interventions are required to mitigate the social and socioeconomic inequities that contribute to the development and progression of CKD and its disproportionate impact on low and middle-income countries.
Public policy for kidney replacement therapy eludes most low- and middle-income countries owing to the seemingly low number of cases and high cost. Countries such as Thailand have shown that public health authorities can effectively provide treatment and elevate health care for populations by overcoming some common challenges.
A critical need exists for innovations in education that increase the recruitment of high school students from diverse backgrounds into the biomedical research workforce. Aspirnaut is one model that addresses this challenge.
Peritoneal dialysis has many advantages over haemodialysis in the treatment of acute kidney injury (AKI) in low-resource settings. One limitation, however, is the availability of commercial dialysis fluid. Following the International Society of Peritoneal Dialysis AKI guidelines, a frontline hospital in Cameroon now shows that locally prepared fluids are safe and effective.
Haemodialysis options for undocumented immigrants with end-stage renal disease range from standard of care thrice-weekly treatments to emergency-only haemodialysis. This latter approach is associated with poor patient outcomes and high costs. The time has come for the nephrology community to demand an end to the practice of emergency-only haemodialysis.
The incidence of kidney diseases from communicable and non-communicable causes is expected to increase globally — especially in low and middle-income countries — as a consequence of global warming. As this increase could lead to overburdening of health-care systems, action is crucial to minimize the negative impacts of climate change on kidney health.
Health-care professionals in general and nephrologists in particular can and should make clear contributions towards achieving the Sustainable Development Goals. This commitment will require changes in patient care, research and education, which should be carried out in collaboration with relevant stakeholders, such as health-care industries.
Current dialysis technologies require vast quantities of pure water; however, water is a finite resource and water scarcity is increasing globally. For dialysis to be sustainable, a critical need exists for innovative approaches that address the consumption and wastage of water by dialysis.
Here, the authors outline the relationship between environmental change and kidney diseases and discuss the environmental impact of kidney care delivery, focusing on dialysis. They highlight existing opportunities to reduce the carbon footprint of nephrology, as well as areas for future research.
Exposure to environmental pollutants is a major cause of kidney injury and disease worldwide and is a particular problem in the developing world. In this Review, the authors discuss the different environmental pollutants that affect the kidney, and our understanding of the pathogenic mechanisms of environmental pollutants in kidney injury and disease.