Dialysis in Africa: the need for evidence-informed decision making.

Chronic kidney disease and acute kidney injury are leading causes of mortality and morbidity in sub-Saharan Africa. Chronic kidney disease accounts for 4 million disability-adjusted life-years (DALYs) lost across the continent annually, just behind diabetes (6·4 million DALYs).1 Increases in the prevalence of hypertension and type 2 diabetes are likely to increase the prevalence of chronic kidney disease in Africa, while high rates of intoxication and infections (such as malaria and HIV) drive acute kidney injury. Many people with acute kidney injury or advanced chronic kidney disease (ie, end-stage renal disease) require renal replacement therapy to remain alive.