Global Disparities in Access and Utilization of Dialysis – Africa, the Disadvantaged Continent

As the burden of CKD continues to increase globally, there remains huge disparities in CKD management and access to treatment in Africa. This review highlights disparities in access and utilization of dialysis in Africa, comparing this with other regions as well as global median values. In-centre hemodialysis is available in all countries in Africa; however, there are significant gaps in its access and utilization across countries. Home hemodialysis is scarcely available in Africa. Peritoneal dialysis utilization is much lower than global medians. These disparities lead to poor health outcomes, poor quality of life, increased morbidity and preventable premature mortality with ethical, psychological and economic impact on the patient, family members and the community, and loss of skilled labor with its consequences on the national economy. Proposed solutions to decrease the impact of these disparities include implementing CKD prevention to reduce disease burden, improved access to essential medicines to slow disease progression, increased peritoneal dialysis utilization, training and retention of skilled nephrology workforce to maintain optimal delivery of care, increased access to kidney transplantation, local production of peritoneal dialysis and hemodialysis consumables, and increased government funding of kidney care to improve patient outcomes, especially in sub-Saharan Africa.