Financial and policy challenges of delivering kidney replacement therapies in resource-limited settings

PURPOSE OF REVIEW: The adoption of a resolution to prevent and control kidney disease at the 2025 World Health Assembly has set the stage for the global community to address barriers in providing life-saving kidney replacement therapy (KRT) in low- and middle-income countries (LMICs) and low-income countries (LICs), where many patients still cannot access dialysis and transplantation. This review will highlight the financial and policy challenges in the delivery of KRT in LMICs and LICs. RECENT FINDINGS: The International Society of Nephrology Global Kidney Health Atlas has highlighted global disparities in financing kidney care in LMICs and LICs, which limits the inclusion of KRT in universal health care coverage plans and leads to suboptimal provision of KRT. Despite transplantation being the most cost-effective modality of KRT, its uptake remains limited and is hindered by various barriers in developing infrastructure and limitations in workforce. In addition, recent geopolitical conflict has introduced complex challenges in delivering care to people needing KRT. SUMMARY: There are various challenges in the successful delivery of KRT in LMICs and LICs. Strategies to optimize financing and provision of KRT, develop transplantation programs, and recruit a capable workforce are needed.