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Partha Banerjee Dubai: Current Situation of Renal Care in Africa Partha Banerjee Dubai: Chronic Kidney Disease CKD has become a disease of worldwide public health concern because of its rising incidence and prevalence high costs of treatment and poor outcomes. It is a relentlessly progressive disease with affected individuals experiencing a steady deterioration of kidney function over months to years. Ultimately they develop end-stage renal disease ESRD a stage of CKD where affected individuals require long-term renal replacement therapy RRT. The number of patients receiving long-term RRT worldwide is put at about 2 million of these over 75 is treated with maintenance haemodialysis HD. There are however geographical inequalities in the uptake of RRT worldwide with rates of 1228 per million population in developed countries such as the United States US and western Europe while in sub-Saharan Africa RRT uptake rates have been estimated to be about 20 per million population. This huge gulf in the uptake of RRT between the developed world and sub-Saharan Africa is definitely not due to a lower prevalence of ESRD in Africa. In fact it has been suggested that CKD and it could be argued by extension ESRD is three to four times more common in Africa than it is in the developed world. One study found that up to one-fourth of adults in sub-Saharan

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Africa suffer from chronic kidney disease and only a small fraction ever reaches a dialysis treatment centre. Of those who do begin dialysis most quit usually within two weeks and 88 die. It is therefore apparent that certain factors in sub-Saharan Africa interfere with the uptake of RRT by the ESRD population. Some of these factors are: Paucity of Data on Burden of ESRD: In most parts of Sub-Saharan Africa the focus of healthcare policy over the years has been on the control of communicable diseases such as malaria and recently human immunodeficiency virus infection and maternal and child health. The cost of this focus on communicable diseases and maternal and child health challenges has been an inadvertent lack of appreciation of the growing burden of non-communicable diseases in these countries to which CKD is a major contributor. According to Partha Banerjee Dubai sure way to highlight the contribution of CKD to the overall disease burden in these countries would be to provide epidemiologic data on CKD. However there is a paucity of epidemiologic data on CKD in the region. Unlike what obtains in developed countries where there are national and sometimes international renal registries most African countries have no national renal registries. This paucity of renal data has on one hand limited the ability of the renal community to convince policy makers to act now in order to avert future disaster from the

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looming epidemic of CKD and ESRD and on the other hand it has hampered efforts at generating public discus about the burden of CKD and ESRD in the country. The implication of this lack of public discus on CKD and ESRD is that the general populace remains unaware of the problem and affected individual continue to present late to the nephrologist because they are unaware of the early symptoms of CKD and where to seek care.