World View

The success of the kidney transplantation programme in Nepal offers lessons in persistence, collaboration and policy reform. In low-resource settings, access to transplantation remains limited, but locally led efforts — supported by training and political will — can shift the landscape and make equitable transplant care possible.

Diagnoses and decisions that we encounter nearly every day as nephrologists are often life-changing for patients. Sometimes, when more than one potential course of action exists, we must give our patients grace and time, allowing them agency in coming to a medically safe shared decision.

Renálida is an organizational model that transforms healthcare coverage into genuine access. In contexts where older adults are excluded from effective care, Renálida offers early and sustained attention through connection, science and meaning. This is an invitation to trust: change is possible when clinical practice is humanized and purposefully organized.

The transition from data scientist to patient–scientist has given me new perspectives into clinical research and strengthened my commitment to open science. Although limitations on data availability have led to frustration, collaboration bodes well for a future in which patients will have access to more personalized information.

Mexico faces a high burden of chronic kidney disease, which is worsened by fragmented health care and a lack of universal coverage for kidney replacement therapy. The Mexico City CKD Project has improved access for uninsured patients through policy reforms, workforce expansion and infrastructure development, demonstrating a scalable model to reduce kidney health disparities.

For women with kidney disease of childbearing age, kidney care should feature discussions of pregnancy, including informed counseling and support. Health disparities between regions with different levels of income are undeniable, but special care programs aimed at the early identification and management of patients at risk can greatly decrease the magnitude of the problem.

The diagnosis of glomerular disease relies largely on meticulous histological and laboratory investigations that continue to improve with technological advances. However, low-income countries such as Uganda lack this investigatory armamentarium and patients are often treated on the basis of suboptimal evidence.

Acute kidney injury (AKI) is a global concern that affects patient outcomes and resource utilization. An effective educational programme aimed at improving early AKI identification, triaging and treatment, using risk scores and care bundles coupled with access to point-of-care diagnostics, can help to prevent AKI-related deaths in regions with limited resources.

Mentoring is an essential component of scientific leadership and can have a profound impact on the development and life course of the mentee. Isi Ero-Tolliver, Dean of the School of Science at Hampton University, describes the life-changing and long-lasting effects of mentorship and why it is important to invest time and effort in mentoring.

To quote Nelson Mandela, “education is the most powerful weapon which you can use to change the world”. Education and training have changed the world of nephrology in Africa for many patients and their physicians, but most low- and middle-income countries still lack access to affordable therapies for kidney disease.

Interruptions to dialysis services in resource-limited settings, like India, amidst the COVID-19 pandemic has highlighted our ill-preparedness. We need alternative plans to safeguard the provision of this life-sustaining treatment and protect our vulnerable patients.

As witnesses to the health consequences of social discrimination, clinicians are uniquely positioned to build coalitions of stakeholders to address inequities and drive change. Such civic engagement is needed to ensure that all populations are given the opportunity to thrive.

Ameliorating the inequitable burden of kidney disease that is experienced by Aboriginal and Torres Strait Islander peoples is an achievable goal. Genuine and committed partnerships between the Australian government, health-care providers and Aboriginal and Torres Strait Islander peoples are imperative to maximize the success of health equity initiatives.

Millions of people in under-privileged regions of the world continue to drink heavily polluted water and die from diarrhoea-related acute kidney injury whilst world super-powers continue to offer military aid to these regions. This gun aid must convert into water aid.

Brazil has been severely affected by the novel coronavirus. At a time when the country needs to concentrate on controlling and fighting the virus, President Bolsonaro has minimized the importance of the pandemic and focused on political battles.