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Author(s): Chad May [1, 2, 3]; Stefano Rivella [1]; John Callegari [1]; Glenn Heller [4]; Karen M. L. Gaensler [5]; Lucio Luzzatto [1, 6]; Michel Sadelain (corresponding author) [1, 2, [...]

Background: Developing sustainable treatment programs for kidney failure in most countries of sub-Saharan Africa continues to remain an imposing challenge. While long-term renal replacement therapies in end-stage renal disease appear beyond national financial capabilities, there exist opportunities for a short-term and affordable treatment of acute kidney injury (AKI). Peritoneal dialysis (PD) is an effective and simpler modality compared to hemodialysis (HD) and can be performed without the need for machinery or electricity, making it an ideal choice in a low-resource setting. Methods: Since cost of treatment is the major obstacle, the goal is to develop a program that is cost effective. Developing an HD program requires a large capital investment by the hospital, needing water treatment systems and machinery and providing for their ongoing repair and maintenance. Gravity-driven PD is a simple, effective modality and can be performed in low-resource locales. Results: In a pediatric program that we started in the Komfo Anokye Teaching Hospital in Kumasi, Ghana, 28 patients have been treated with PD for AKI so far. Half of them were treated successfully and were discharged having fully recovered kidney function. Seven patients (25%) were determined to have end-stage renal disease, whereas 7 others (25%) died during hospitalization. In these cases, late presentation for dialysis may have contributed to the inability to recover. Conclusion: For individuals and governments alike, who are concerned about the cost of providing or paying for dialysis, using PD to treat AKI is an effective and simpler modality compared to HD and can be performed without the need for machinery or electricity, making it an ideal choice in a low-resource setting. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Shows that the use of recombinant lentiviruses enables efficient transfer and faithful integration of the human beta-globin gene together with large segments of its locus control region. Speculation that the stable introduction of a functional beta-globin gene in hemotopoietic stem cells could be a powerful approach to treat beta-thalassemia and sickle-cell disease; Findings of experiments with beta-thalassemic mice; Conclusion that such therapy should be of benefit to patients with severe defects in hemoglobin production.

Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania.

To date, no sustainable treatment program exists for kidney failure in countries in sub-Saharan Africa. No data are available on the incidence, prevalence or cause of chronic kidney disease (CKD). The world's focus has been on treating 'priority diseases' as defined by the United Nations Millennium Project and the World Health Organization because of their high mortality rates. This is understandable because HIV/AIDS, tuberculosis, diarrheal diseases and malaria claim majority of the lives; however, in many cases, the mortality is due to acute renal failure (ARF) as a consequence of the progression of these diseases. Moreover, to date, no data are available on mortality rates due to ARF as a consequence of these 'priority diseases.' Sustainable Kidney Care Foundation (SKCF), working with industry, institutions, universities and funding organizations, is in the process of establishing a pilot program for the treatment of acute renal failure (ARF) using peritoneal dialysis (PD) as the modality of choice with a special focus on treating children and women of childbearing age in the United Republic of Tanzania.