World View in 2025

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.