Table 2.

Challenges to providing comprehensive kidney care in Kenya (9)

Patient factors	Late presentation Poverty—contributes to poor adherence, poor nutrition, and inability to afford medications More reliance on temporary vascular access
Medications	Iron and erythropoietin are expensive and paid for out-of-pocket Inadequate vaccination of patients on KRT
Diagnostic tests	Evaluation of anemia and mineral bone diseases limited Cost of serological screening (HIV, hepatitis B, hepatitis C) and screening for hepatitis B antibody responses Inadequate renal histopathology support, very limited access to electron microscopy Water quality analysis costly and availability limited
Dialysis and transplantation	Low usage of PD Only twice-weekly HD funded Low transplant rates
Infrastructure	Capacity of HD units not meeting demand Lack of a reliable supply chain for dialysis consumables
Human resources	Few nephrologists, vascular surgeons, renal nurses, and renal technologists

HD, hemodialysis; PD, peritoneal dialysis; KRT, kidney replacement therapy.