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Treatment of chronic kidney disease requires a comprehensive approach including universal access to early diagnosis and to medications that can slow disease progression. Such equitable access is not only an ethical requirement but can also reduce the financial and human costs of advancing kidney and cardiovascular disease.
Overcoming barriers to deliver high-quality care requires an assessment of the contribution of each barrier within a local context. Tools to identify early disease, knowledge of best therapies, access to care providers and medications, and an accountable and integrated health-care system are essential elements of quality care. Education of patients, providers and policy makers in conjunction with advocacy efforts and national policy frameworks are required to deliver high-quality care worldwide.
Many countries worldwide, particularly those with low or lower-middle incomes, do not have enough nephrologists to provide health services for patients with kidney disease. Increasing training opportunities, improving job satisfaction and using new technologies and advances in artificial intelligence could help to increase the nephrology workforce and improve patient outcomes.
Improved understanding of the impact of sex and gender-related factors on human health and disease and the inclusion of people of all genders in research studies is necessary to reduce health inequities and enable a more personalized approach to patient care.
The current nomenclature for cardiorenal syndrome is problematic owing to its chronological approach and the systemic nature of some of the subtypes. We suggest adoption of a new concept, chronic cardiovascular–kidney disorder, that better reflects the contributions of common risk factors and shared pathophysiological mechanisms.
First Nations peoples in Australia face systemic inequities in access to kidney transplantation. The National Indigenous Kidney Transplant Taskforce was established to address these. It has provided support to clinicians to implement and evaluate innovative practices and developed strategies to address biases in the structures and models of care that create barriers to wait-listing.
Digital transformation offers unprecedented opportunities for advancing healthcare, but also raises complex ethical and legal challenges. Emerging drivers of health disparity termed ‘digital determinants of health’ call for purposeful, equity-focused strategies to ensure that technological innovation benefits all without exacerbating disparities.
The diagnosis of glomerular disease relies largely on meticulous histological and laboratory investigations that continue to improve with technological advances. However, low-income countries such as Uganda lack this investigatory armamentarium and patients are often treated on the basis of suboptimal evidence.
Among global destabilizing events, natural disasters often receive widespread attention whereas protracted conflicts and economic crises fade into the background. Low- and middle-income countries bear the brunt of this indifference, resulting in severely weakened health systems. People who require dialysis are particularly vulnerable, necessitating urgent collaboration to ensure equitable and sustainable care during such crises.