Kidney Disease in Disadvantaged Populations

The challenges and dilemmas faced by disadvantaged populations with kidney disease are tremendous. Patients, health care providers, and investigators struggle to manage and understand the high burden of disease, the practical approach to delivery of high cost renal replacement therapy with limited resources, implementation of preventive strategies , and the difficult ethical dilemmas. The purpose of this special issue is to shed light on the understudied challenge of kidney disease in disadvantaged populations. The papers in this special issue serve as an example of the excellent research conducted in developing countries, many times in collaboration with investigators in developed countries. Coincidentally, the majority of papers include authors from Nigeria, a country which likely is representative of sub-Saharan Africa. In editing this special issue, the barriers faced by investigators from developing countries were evident and include lack of funding, limited forums to disseminate their work, the peer review process, and lack of resources. Along with a topical review article " Chronic Kidney Disease in Disadvantaged Populations, " the papers in this issue provide an overview of some of the important issues in sub-Saharan Africa including new biomarkers for kidney disease, " Circulating Adiponectin Is Associated with Renal Function Independent of Age and Serum Lipids in West Africans " ; association between APOL1 and HDLc, " Variation in APOL1 Contributes to Ancestry-Level Differences in HDLc-Kidney Function Association " ; early markers of kidney disease, " Prevalence and Correlates of Microalbuminuria in Children with Sickle Cell Anaemia: Experience in a Tertiary Health Facility in Enugu, Nigeria " and " Association between Urinary N-Acetyl-Beta-D-Glucosaminidase and Microalbu-minuria in Diabetic Black Africans " ; alternatives to high cost erythropoiesis-stimulating agents, " Meta-Analysis of Ran-domized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries " ; and the disturbing issue of how to best provide care to patients with end-stage renal disease (ESRD), " A Single-Center 7-Year Experience with End-Stage Renal Disease Care in Nigeria—A Surrogate for the Poor State of ESRD Care in Nigeria and Other Sub-Saharan African Countries: Advocacy for a Global Fund for ESRD Care Program in Sub-Saharan African Countries. " In many countries, dialysis is not an option for patients with ESRD. According to Dr. Saraladevi Naicker, the burden of kidney disease is thought to be high in sub-Saharan Africa, but the dialysis treatment rate ranges from 70 patients per million population in South Africa to …