Assessing and Improving the Capacity of District Health Services in the Management of Acute Kidney Injury in Low- and Middle-Income Countries

摘要

The burden of acute kidney injury (AKI) is predicted to be high in low- and middle- income countries (LMICs), with a number of differences compared with AKI encountered in better- resourced parts of the world. 1 AKI is predominantly community acquired and affects younger pa- tients in LMICs, and high rates of HIV coupled with an increasing prevalence of noncommunicable diseases such as diabetes and hy- pertension make patients here at particular risk of kidney disease. Although the main causes of AKI (infectious illness, hypovolemia, and nephrotoxin use) in LMICs are preventable and treatable, delayed presentation, lack of diagnostic capacity, and limited resources for management mean outcomes for patients are currently poor. 2,3 Service improvement initiatives, such as the International Society of Nephrology (ISN) 0by25 and Kid- ney Care Network Projects (www.theisn.org/programs/isn- kidney-care-network, accessed May 1, 2020), have been estab- lished to address these concerns.