Chronic kidney disease (CKD) continues to represent one of the most significant and growing public health challenges worldwide, with a disproportionate burden falling on low- and middle-income countries (LMICs). According to data published in The Lancet (2020) by Bikbov et al. as part of the Global Burden of Disease study, more than 697 million individuals were affected globally in 2017, with age-standardized prevalence and mortality rates highest in sub-Saharan Africa and Oceania.
The International Society of Nephrology has consistently emphasized the need for systematic data collection and healthcare infrastructure development in regions where CKD remains underdiagnosed. Through its Global Kidney Health Atlas (GKHA), first published in Kidney International Supplements (2017) and updated in subsequent editions, ISN mapped gaps in nephrology workforce, dialysis availability, and transplantation capacity across more than 160 countries, revealing stark disparities that demand targeted policy responses.
In LMICs, CKD progression is frequently accelerated by the prevalence of untreated hypertension, type 2 diabetes mellitus, and recurrent episodes of acute kidney injury linked to infectious diseases, dehydration, and limited access to nephrotoxic drug monitoring. These compounding risk factors create a clinical environment where early-stage CKD rapidly advances to end-stage renal disease (ESRD) without adequate interventional capacity.
Screening programs based on urinary albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) have demonstrated effectiveness in identifying at-risk populations in resource-limited settings. The ISN-supported Saving Young Lives program, documented in NDT Plus and Clinical Journal of the American Society of Nephrology, has evaluated community-based screening models in Africa and Asia, supporting adaptation of protocols for community health worker deployment in rural areas.
The scientific and clinical significance of addressing CKD in LMICs extends beyond individual patient outcomes. ISN’s 0by25 Initiative, launched to eliminate preventable deaths from acute kidney injury by 2025 and described in publications in Kidney International (2015, Mehta et al.), drew global attention to the catastrophic human cost of untreated kidney disease in low-resource environments. Coordinated international action, grounded in evidence-based medicine and health equity principles, remains essential to reversing these trends.