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Semin Nephrol. 2017 May;37(3):260-272. doi: 10.1016/j.semnephrol.2017.02.006.

Integration of Care in Management of CKD in Resource-Limited Settings.

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Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa. Electronic address:
Department of Medicine, University of Alberta, Edmonton, Canada.
Zenith Medical and Kidney Centre, Garki, Abuja, Nigeria.
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.


The prevalence of noncommunicable diseases, including chronic kidney disease (CKD), continues to increase worldwide, and mortality from noncommunicable diseases is projected to surpass communicable disease-related mortality in developing countries. Although the treatment of CKD is expensive, unaffordable, and unavailable in many developing countries, the current structure of the health care system in such countries is not set up to deliver comprehensive care for patients with chronic conditions, including CKD. The World Health Organization Innovative Care for Chronic Conditions framework could be leveraged to improve the care of CKD patients worldwide, especially in resource-limited countries where high cost, low infrastructure, limited workforce, and a dearth of effective health policies exist. Some developing countries already are using established health systems for communicable disease control to tackle noncommunicable diseases such as hypertension and diabetes, therefore existing systems could be leveraged to integrate CKD care. Decision makers in developing countries must realize that to improve outcomes for patients with CKD, important factors should be considered, including enhancing CKD prevention programs in their communities, managing the political environment through involvement of the political class, involving patients and their families in CKD care delivery, and effective use of health care personnel.


CKD; chronic disease management; health policy; integrated care

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