Table 2.

Impact of each SDoH on kidney health outcomes and adaptive measures.

SDoH	Impact	Adaptive measure
Health Care system	•Impact on hemodialysis and peritoneal dialysis services. •Quality of health care. •Health care accessibility	•Screening for diseases like diabetes mellitus, hypertension kidney dysfunction in the high-risk population. •Improve physician-patient density. •Provision of medical insurance for dialysis. •Improving access to the health care system
Education	•Poor education status has been linked with CKD development	•Development of government policies focusing on providing universal access to school education.
Social and community context	•Racial and gender discrimination •Cultural beliefs •Use of alternative medications	•Policy development for the provision of equity in the health care system (Without racial and gender bias) •Encouragement of community support and social integration. •Creating awareness and providing knowledge about treatment options.
Poverty and unemployment	•Food insecurities and housing insecurities are associated with incident CKD development. •Malnutrition causes substantial mortality and morbidity in CKD patients. •Low SES causes reduced access to healthcare facilities, non-affordability, limited follow-up care, and delayed treatment. •Maternal nutrition during pregnancy is associated with a higher likelihood of metabolic, cardiovascular, and kidney disease in the offspring	•Improving food housing and security, particularly for vulnerable (including patients with kidney diseases) and underprivileged populations. •Providing more job opportunities with health insurance (including dialysis services). •Development of policies to provide proper maternity care (Free antenatal and postnatal care provision, focus on maternal nutrition and co-morbidities)
Environment exposures	•Association of rising pollution with a higher rate of GFR decline and glomerular diseases •Housing condition: Heavy metal exposure have been reported to be associated with AKI, tubular •glomerular diseases and CKD •Hot climate is implicated in causative factors of CKDu •Higher risk of infectious diseases with poor sanitation and overcrowding. •Higher incidences of nephrolithiasis, AKI, Vector-born and zoonotic diseases with global warming	•Application of stringent laws to stop global warming and preserve biodiversity. •Development of new policies to provide sustainable living conditions to all. •Adequate preparations to deal with hindrance caused by extreme weather in patient and doctor transportation, regular dialysis facilities. •Provision for screening, vaccine and treatment facilities for infectious diseases particularly in tropical and sub-tropical regions.
Political and legal factors	•Direct and indirect impact on kidney outcomes as influence universal health care and health care system, promote gender and racial equality and prevent malpractice.	•Government policies for dialysis and renal transplantation. •Development of legal framework to provide clean water supply, housing conditions, education and ensure equitable health care •Law enforcement againstorgan trading

AKI, Acute kidney injury; CKD, Chronic kidney diseases; SES, Socioeconomic status; SDoH, Social determinants of health.