ISN Fellows report
Gavin Dreyer, Renal SpR, Royal Free Hospital, London
Kidney disease in resource limited settings is an under-recognised and under-treated
condition. Many young lives are lost as a consequence of the late detection and poor
management of both acute and chronic kidney disease. The huge cost of dialysis (both
haemo and peritoneal) means that dialysis services are either not accessible to the general
population or incur significant financial strain on patents requiring dialysis. The government
of Malawi has provided both haemo and peritoneal dialysis free at the point of care since
1998. However, the cost of these services consumes a disproportionate amount of the
national health budget of Malawi for the number of patients treated.
For the last 3 years, I have worked in Blantyre, Malawi, initiating and sustaining a
comprehensive nephrology service. Working with and training local Malawian multidisciplinary staff has led to the sustainable provision of both dialysis and non-dialysis
services including screening and detection of early kidney disease, a new peritoneal dialysis
service and, more recently, a focus on the better detection and management of acute kidney
injury.
There are significant opportunities but also complex challenges in Malawi and the region to
improve the care of patients with kidney disease. While many of the resources exist to treat
both acute and chronic kidney disease, there needs to be a major reorganisation of the
delivery of care for kidney disease to improve outcomes and save lives. While part of this
includes upgrading and strengthening dialysis services, research programmes which focus
on improving the detection and better management of the early stages of kidney disease
using existing human and clinical resources are essential.
International collaborations, supported by global nephrology organisations such as the
International Society of Nephrology and the UK Renal Association have the potential to
dramatically enhance the care of and outcomes from kidney disease in resource limited
settings. The challenge for the international nephrology community is to strengthen and
sustain these collaborations and support better research into kidney disease in resource
limited settings.