1) the low overall patient numbers reported suggest that many patients with acute kidney injury are not diagnosed or treated
2) male patients predominate, probably showing some discrimination against women: this might reflect a true increased susceptibility to renal disease (eg, urogenital abnormalities in boys), but more probably reflects the relative absence of economic and decision-making power among women, and is consistent with findings in other low-resource regions
3) poor patient resources led to delays in admission to hospital and use of traditional medicine, which might be especially harmful in the setting of dehydration, for example, and worsen kidney injury
4) delays occur in referral from peripheral health-care sites to sites where renal care is available. Delays also occur after admission to hospital because patients need to search for funds to pay for dialysis or because supplies, staffing, or resources of the hospital are erratic. Each of these delays might have a seemingly obvious cause, but if a holistic approach is to be taken to prevent acute kidney injury, much research, including clinical, epidemiological, and anthropological study, is needed to investigate all contributors to such barriers.
Among the authors of this review, several ISN leaders continue to contribute to the understanding and treatment of unresolved issues in disadvantaged regions: Drs. Abdou Niang, Charlotte Osafo, Gloria Ashuntantang, Fatiu Arogundade, Saraladevi Naicker, Valerie A Luyckx.
The full article on The Lancet website: http://www.thelancet.com/…/PIIS2214-109X%2815%2900…/fulltext