Lausanne, December 7, 2021 – Nephrologists in Switzerland and Africa are the first to discover details of an innovative alliance aimed at addressing the extreme gap in access to dialysis therapies in low- and middle-income countries (LMICs), compared to higher income countries.
The interdisciplinary RENal care for ALL Alliance (Ren’All Care) brings together experts from key organizations in Europe and Africa: the EssentialTech Centre of the Swiss Federal Institute of Technology (EPFL), the African Association of Nephrology (AFRAN), the Francophone Society of Nephrology, Dialysis and Transplantation (SFNDT), the Swiss Society of Nephrology (SSN), and the University of Witwatersrand, Johannesburg (WITS).
The Ren’All Care Alliance will be presented in parallel at the Annual Meeting of the SSN in Interlaken (December 9-10) and at the AFRAN/AFPNA Congress for nephrologists from across Africa, hosted this year in Abidjan by the Ivorian Society of Nephrology (December 8-10). The theme of the AFRAN/AFPNA Congress, advocacy for kidney disease management in Africa, is particularly aligned with the Alliance’s goals.
Just one or two sessions of dialysis is often all it takes to save the life of someone suffering from acute kidney injury. Yet a 2016 review study published in the Lancet Global Health estimated that in sub-Saharan Africa, 86% of adults and 73% of children die when in need of short-term dialysis, due to lack of access. 1 The societal burden of preventable morbidity and mortality due to kidney disease in LMICs is particularly high, since it affects a much younger population.
Dialysis role and procedure. Vital roles of kidneys are to clear blood from toxins and control the body water balance. When kidneys are damaged and cannot performed their function anymore, either kidney transplantation or dialysis is used as a replacement therapy. This illustration shows a woman under hemodialysis treatment, one of the dialysis methods where blood is cleaned outside the patient’s body in the dialysis machine. The process is complex and requires several hours. Photo credit @icrc.
The Alliance has identified several contributing factors to lack of access to kidney treatment in Africa: Limited capacity due to lack of dialysis equipment, especially outside of cities; the high cost and complexity of dialysis; lack of specialized training among health workers; necessity of monitoring and risks of severe infection among dialysis patients; and absence of kidney disease registries.
“This joint mission is interesting because we are targeting an area where a significant impact is attainable,” says Prof. Abdou Niang, President of the African Association of Nephrology and chair of the International Society of Nephrology (ISN) Dialysis Working group. “This is particularly true in the case of acute kidney disease that can be treated with a few sessions of dialysis – as is the case in Western countries. However, in sub-Saharan Africa, especially in rural areas, this is not available. If we bring appropriate technology and training to community health clinics, we will save countless children and adults in hours or days, who can then go on to live normal lives.”
Through a Joint Declaration of Intent, the institutions partnering in Ren’All Care have agreed to collaborate on a project to develop a sustainable solution on three fronts. They will design affordable, robust technology adapted to the context, promote training programs and implement epidemiological registries and medical guidelines co-created with local health systems.
During the induction phase of the project, the institutions will conduct a comprehensive analysis of existing dialysis techniques in LMICs, determining barriers and obstacles in these contexts. “By gaining a clearer picture of the situation, we will be better positioned to determine our course of action in terms of innovative design concepts,” explains Dr. Klaus Schönenberger, Director of the EssentialTech Centre. “With our combined expertise, we are well-positioned to develop and ultimately implement an effective technology solution. This includes robustness, ease of use, economic viability, affordability and environmental-friendliness, which are all vital to generating a sustainable impact.”
“To ensure our ultimate success, it was important to come together formally as an alliance and commit to this Joint Declaration of Intent,” adds Prof. Rudolf Wüthrich, President of the Swiss Society of Nephrology. “Our process covers the three key pillars of innovation, training and epidemiology. By bringing together such complementary expert partners, we guarantee the right balance of expertise in all these areas for the duration of this important initiative, enhancing its overall potential and sustainability. We are currently seeking the necessary support and resources to enable us to launch this ambitious initiative.”
1Olowu et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review, The Lancet 2016.