Friday Wokoma^{1, 2}, Pedro Emem-Chioma^{1, 2,}, Manda David-West²

In the Low and middle income countries (LMIC) CKD and ESRD constitute a major cause of morbidity and mortality affecting predominantly the young and middle age groups with far reaching socioeconomic implications. The exact data are not available, the prevalence of CKD and the incidence of ESRD in most LMIC jurisdictions are about 10-17% and over 1500 per million populations (pmp), respectively, though RRT prevalence averages 255pmp. The burden of human suffering is enormous and the financial burden of care is far beyond the reach of the individual sufferer and most LMIC countries are incapable of providing Medicare type of care for their subjects with ESRD. Thus the diagnosis of ESRD in most LMIC countries is synonymous with a death sentence. In the present state of practice in the LMIC countries, the unmet need of nephrology practice is the challenge of reducing the burden of CKD and ESRD in the communities through preventive nephrology approach. Even in developed countries with state of the art facilities for care, there is the prevailing need for reducing the burden of CKD in recent times. CKD and ESRD preventive programs such as the KEEP and similar programs are in place. KEEP-like programs are unfortunately not appropriate for LMICs on account of technology and IT attributes. Paradoxically, in most LMIC jurisdictions with the highest burden of ESRD and the least in access to care, there are no forms of structured sustainable CKD/ESRD containment programs. Some previous efforts in this direction could not be sustained because they were not integrative in nature and were funded by donor agencies. We propose the Community (PHC)-Renal Centre linkage program which would enable a permanent link between the rural based PHC centres with urban based Renal centres. This pivotal link will be achieved through the services of purpose trained Community Preventive Nephrology practitioner (CPN-P). The CPN-P identifies and manages CKD risk factors and early CKD cases at the PHC level and transfers advanced stages to the affiliate Renal centres in teaching and specialist hospitals. The CPN-P bridges the long missing nephrology care gap in the LMIC jurisdictions. With good record keeping Renal data from the communities would be used to develop Renal Registry in the area.

LIMC, CKD, community, renal centre, linkage, program