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Kidney replacement therapy for acute kidney injury in low-resource settings: Lessons from Africa
Yasser M Abdelhamid, Department of Internal Medicine, Nephrology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo 12111, Egypt
Ahmed Fayed, Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo 12111, Egypt
Yannick Mayamba Nlandu, Nephrology Unit, University of Kinshasa Hospital, University of Kinshasa, Kinshasa 11, Kinshasa, Congo
Sudakshina Ghosh, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania
Sudakshina Ghosh, Department of Internal Medicine, Ampola Regency Hospital, Dar es Salaam 107076, Tanzania
Author contributions: Abdelhamid YM conceived the study, developed the review framework, supervised the project, interpreted the evidence, and critically revised the manuscript for important intellectual content; Fayed A performed the literature search, reviewed and synthesized the evidence, drafted the manuscript, prepared the tables and figure, incorporated reviewer-requested revisions, and coordinated preparation of the final version; Nlandu YM contributed African regional expertise, interpreted the evidence within the context of low-resource settings, and critically revised the manuscript; Ghosh S contributed to evidence interpretation, provided regional clinical perspectives, and critically revised the manuscript; all authors contributed substantially to the intellectual content of the work, approved the final manuscript, and agree to be accountable for all aspects of the work.
AI contribution statement: AI-assisted technology was used solely to support language refinement, manuscript organization, and editorial improvements during manuscript preparation. All scientific content, literature selection, interpretation of evidence, critical analysis, conclusions, and final editorial decisions were performed and verified by the authors. The authors take full responsibility for the accuracy, integrity, and originality of the manuscript and have reviewed and approved the final version submitted for publication.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript. The authors have no financial relationships, commercial associations, consultancies, stock ownership, honoraria, paid expert testimony, patent applications, or other competing interests that could be perceived as influencing the content of this review.
Corresponding author: Yasser M Abdelhamid, MD, Full Professor, Professor, Department of Internal Medicine, Nephrology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12111, Egypt. dyabdelhamid@kasralainy.edu.eg
Received: April 13, 2026
Revised: June 24, 2026
Accepted: July 1, 2026
Published online: September 25, 2026
Processing time: 124 Days and 19 Hours
Revised: June 24, 2026
Accepted: July 1, 2026
Published online: September 25, 2026
Processing time: 124 Days and 19 Hours
Core Tip
Core Tip: In low-resource settings, the critical question in acute kidney injury (AKI) is often not which kidney replacement therapy modality is theoretically superior, but which one can be started quickly, delivered safely, and sustained reliably. Because comparative trials have not shown clear outcome superiority of one modality across all patients, context-adapted use of intermittent hemodialysis and peritoneal dialysis, supported by earlier diagnosis, better referral pathways, and workforce training, offers the most realistic strategy to reduce preventable deaths from AKI in Africa and similar settings.