Kidney Week 2025 Annual Meeting-CKD in Limited-Resource Settings: Epidemiology, Clinical Presentations, and Treatment

Video Transcription

Video Summary

The session “CKD in Unlimited Resource Settings” focused on chronic kidney disease (CKD) epidemiology, prevention, treatment realities, and genetics in low- and middle-income countries (LMICs), with emphasis on sub-Saharan Africa.<br /><br />Professor Vincent Boima described CKD as a rapidly growing global cause of death, disproportionately affecting LMICs where prevalence (14–36%) exceeds global averages and patients develop CKD and kidney failure decades earlier (often 40s vs 60s in high-income countries). Drivers include hypertension, diabetes, infections (HIV, hepatitis), glomerular disease, genetic risk (APOL1), sickle cell disease, and environmental exposures (NSAIDs, herbal remedies, heavy metals, heat stress). Major barriers are late presentation, low awareness, limited lab capacity (eGFR/ACR often unavailable), weak registries, scarce biopsy and pathology services, and severe workforce shortages. Access to kidney replacement therapy (dialysis/transplant) is extremely limited, largely out-of-pocket, and often unaffordable. Proposed solutions included integrating CKD into NCD programs, task-shifting to community health workers, telemedicine/mHealth, local manufacturing of dialysis supplies, public-private partnerships, and establishing registries and LMIC-specific risk models.<br /><br />Professor Ifeoma Olasi emphasized prevention and primary care integration, outlining phased implementation: assess burden/resources, build workforce capacity, risk-stratified screening, simple referral pathways, essential diagnostics (dipstick, point-of-care creatinine), and affordable therapies (ACEi/ARB, generics). Financing models (tax-based, insurance, mixed) and universal health coverage were highlighted, alongside community engagement and monitoring.<br /><br />Dr. Duomo Edu discussed “moral distress” when dialysis must be rationed in Ghana, where costs exceed wages and most patients historically died untreated. Recent national insurance promises limited free dialysis, but sustainability remains uncertain; prevention, policy advocacy, and philanthropy are key.<br /><br />Dr. Rulan Parikh reviewed APOL1 risk variants, showing wide regional/ethnic variability in Africa and strongest associations (e.g., G2/G2 with FSGS). She stressed gene–environment interactions, the need for longitudinal African studies, and ongoing APOL1-targeted trials, while noting hypertension screening may be a practical prevention entry point.

Asset Subtitle

Moderator(s): Anthony Muiru, Opeyemi Olabisi

Presentation(s):

Epidemiology, Etiologies, Prevention, and Treatment of CKD in Low-Resource Settings - Vincent Boima
Implementing Preventive and Therapeutic Strategies for CKD with Limited Resources and Support - Ifeoma Ulasi
Moral Distress and Mitigation Strategies When Dialysis Treatment Must Be Rationed - Dwomoa Adu
Findings from Major Collaborative CKD Studies in Low-Resource Settings: H3Africa and Others - Rulan Parekh

Meta Tag

Date 11/7/2025

Pathway 1 CKD Non-Dialysis

Pathway 2 Dialysis

Session ID 511034

Keywords

chronic kidney disease (CKD)

low- and middle-income countries (LMICs)

sub-Saharan Africa

CKD epidemiology

early-onset kidney failure

hypertension

diabetes mellitus

HIV and hepatitis infections

glomerular disease

APOL1 risk variants

focal segmental glomerulosclerosis (FSGS)

environmental nephrotoxins (NSAIDs, herbal remedies, heavy metals)

limited diagnostics (eGFR, ACR, dipstick, point-of-care creatinine)

kidney replacement therapy access (dialysis, transplant)

universal health coverage and financing models