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Acute Kidney Injury (AKI) is an ongoing concern in Malawi. Many simply do not know that if identified early, it is often easily treatable with fluids and antibiotics. The availability of acute dialysis is also very limited, particularly outside Blantyre.

The ISN Sister Renal Center (SRC) partnership between and Royal London Hospital, UK and Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, reveals how education is gradually changing kidney patient care in the country. Gavin Dreyer helped set up the collaboration in 2011 and a recent trip back highlighted the value of community awareness.

Last November, Dreyer returned to Malawi with ISN Program Chair John Feehally to meet colleague Rhys Evans (UK), who is spending a year in Blantyre to help strength- en renal services including a new hemodialysis unit.

The unit provides an inpatient renal referral service hospital-wide, renal replacement therapy for AKI and end-stage renal disease patients, as well as weekly and monthly renal outpatient clinics for adults and children. So far, 11 patients have received acute hemo-dialysis treatment with encouraging results.

However, Evans believes there is still a lot to learn about AKI at QECH and in district hospitals around southern Malawi, including basic data on etiology, incidence and out- comes. “We hope to answer some of these questions over the next year as we roll out several ISN-supported AKI research projects,” he adds.

AKI education and training have always been a focus of renal services in Malawi. In 2014, AKI-specialist nurse Kelly Wright (UK) led a successful program in Blantyre, educating nursing staff on AKI prevention, diagnosis and treat- ment. This covered caring for acutely unwell patients, identifying those at risk of AKI and the importance of volume assessment and fluid monitoring.

The team is now re-auditing AKI management in the hemodialysis unit and general medical wards. Dreyer believes there is great potential for extending teaching and training in the country. There are plans to hold an AKI Symposium in March to raise awareness about general AKI management and renal services at QECH.

Education needs to move beyond hospitals. During the recent trip, visiting village health centers was a first step towards sensitizing local communities and improving prospects for preventing and treating AKI.

Communities need to understand the importance of good water sanitation and the use of mosquito nets to prevent AKI. Healthcare workers should be aware of simple clinical tests to identify AKI includ- ing assessing urine output and point of care tests like a salivary urea strip, which is under evaluation.

Aside from greater community awareness and better education for healthcare workers, there is also a lack of data on kidney disease so it is difficult to estimate the burden or measure the benefits of inter- ventions. Thanks to the SRC partnership, some data has already been gathered on acute peritoneal dialysis in children. But, informa- tion on the causes, frequency and severity of kidney disease in adults, children and particularly obstetric cases is needed. “We have plans for a comprehensive hospital study of AKI starting in the acute medical wards at QECH,” adds Evans.

“All these excellent developments in Malawi can progress more quickly if we develop stronger partnerships with the Saving Young Lives Program and the ISN 0by25 initiative0by25 initiative so that we can plan a common agenda,” says ISN Program Chair John Feehally.

The Blantyre team is planning to outline the unit’s progress activities during the World Congress of Nephrology in Cape Town in March and the satellite symposium on nephrology in disadvantaged popu- lations shortly after the congress.

For further information about the WCN 2015 sessions and satellite symposia, click here.

To find out more about the ISN Programs, click here.

About Blantyre

Malawi Blantyre is in southern Malawi, not far from the border with Mozambique. With a population of over 600,000 it is the country’s second biggest city behind the capital Lilongwe. Queen Elizabeth Central Hospital is a tertiary referral centre for southern Malawi with over 1000 inpatient beds. There are around 30 medical admissions per day with over 200 general medical inpatients.