MaryCarter 1,2 Fred Finkelstein 2,3, Karen Yeates 4, Peter Kotanko1,2 , Nathan W Levin1,2 , John Callegari 1,2 1 Renal Research Institute, New York, NY, USA; 2 Sustainable Kidney Care Foundation,  New York, NY USA;  3 Yale University, New Haven, CT, USA;  4 Queens University, Kingston, ON Canada

  Introduction There is an increasing need for treatment of AKI in low and middle income countries (LMIC) where the availability of renal services is minimal and those with the availability of renal replacement therapies have limited use of HD and even fewer options for transplantation. The Sustainable Kidney Care Foundation (SKCF), working with industry and professional societies works on starting PD programs for AKI with a focus on saving the lives of children and women of childbearing age. In developing countries pregnancy is still responsible for 15-20% of all AKI cases. Sub-Saharan Africa and southeast Asia accounted for 85% of the global maternal death rate in 2010, and in children under 5 years old, between 2000 and 2003, 0.6 million died from malaria and 1.4 million died from diarrheal diseases. Although electrolyte and fluid repletion and mosquito nets have made a difference, children are dying from AKI resulting from both causes as above. Program The SKCF model focuses on sustainability and capacity building for local communities. The participating hospitals need to have a well working laboratory and  trained clinical staff, including doctors who can perform PD catheter placement and nurses. PD consumables are donated for 2 years during which payment from insurance and/or patients are saved and used for supplies for subsequent years of PD treatments.



Program (continued) PD was selected as the modality of choice as it can be provided in low technology settings as opposed to HD, which requires major capital expenditures. Training has been provided by ISN, ISPD and IPNA. Results Successful programs are ongoing in Tanzania and Ghana, with new programs starting in Benin, Cameroon  in the planning stages are programs in Ethiopia and Uganda.  85% of treated patients have had a full recovery of their kidney function after an average of 10 treatment days. One of the challenges continues to be educating healthcare workers in remote areas to recognize AKI for early referral as late presentation continues to be a major factor in dealing with AKI and in those treated who do not recover. Conclusion PD for AKI programs are important catalysts for starting  national discussions about kidney disease prevention and treatment including insurance coverage for kidney disease and especially in rural communities, training in prophylaxis against AKI. Although kidney disease was only peripherally mentioned in the WHO - UN’s September 2011 meeting calling for the reduction of 4 major non-communicable diseases: heart attacks, strokes, cancer and respiratory disease, saving lives with adequate dialysis is and absolute requirement.