Nephrology in Nepal: How it Started and Where We Are.

Nepal has made significant strides in nephrology, progressing from no dialysis services to offering comprehensive kidney care, including dialysis and transplantation. The journey began in the 1980s with the establishment of the first nephrology unit at Bir Hospital and has since grown to encompass over 60 dialysis centers and multiple transplant facilities. Government initiatives, such as financial subsidies and health insurance schemes, have increased accessibility, yet disparities persist due to workforce shortages, uneven infrastructure distribution, and inconsistent quality control in dialysis services. Pre-dialysis care remains underdeveloped, and challenges in adopting peritoneal dialysis persist due to socioeconomic and logistical barriers. The kidney transplant program, primarily reliant on living donors, has shown steady growth. Critical care nephrology and interventional services are gradually emerging. To advance, addressing workforce shortages, improving care quality, and expanding equitable access through strategic investments and global partnerships are essential.