Project Lead(s): Kajiru Kilonzo, Karen Yeates
Acute kidney injury (AKI) can be caused by a number of illnesses, such as infection (sepsis, malaria, dengue, ebola) or severe dehydration from diarrhea. It is also common in post-partum hemorrhage and pre-eclampsia, with poor outcomes in settings such as Tanzania, due to lack of an adequate healthcare infrastructure and blood supply.
If AKI goes unrecognized, it can result in severe kidney damage and death due to chronic kidney failure. Management of chronic kidney failure is a challenge in Tanzania, where there are no dialysis facilities to treat the population needing long-term treatment.
The objective of this project was to develop or source a commercially available, low-cost, point-of-care test for use in low-resource settings to measure kidney function at the bedside, combined with a non-physician health worker education and training program for health facilities in the Kilimanjaro region of Tanzania.
The program also evaluated a mobile (tablet-based) patient identification decision support tool to increase identification of acute kidney injury and appropriate management, with referral to a higher level of care, if required.
The intervention utilized the 5R approach to the management of AKI, namely, risk assessment, early recognition, appropriate response, renal support and rehabilitation.
The project has located and tested a commercially available, low-cost, point-of-care test that is being used in a multi-country study (with Tanzania being the key pilot site), to evaluate use of the test in conjunction with a health provider education and training program to improve recognition of AKI, as well as its management.
The project team has spent the last 18 months working directly with the International Society of Nephrology (ISN) in the intervention phase of their ‘0 by 25’ (0 preventable deaths from AKI by 2025) initiative.
To date, the team has developed educational tools and a formal protocol that has been implemented in four countries (Tanzania, Nepal, Bolivia and Malawi).
The project is still ongoing with funds and support leveraged from the International Society of Nephrology. Preliminary results from all four pilot countries are expected by late 2017.