Mg. Zuñiga-San Martin, Carlos

A key component of treatment for all people with advanced kidney disease is supportive care, which aims to improve quality of life and can be provided alongside therapies intended to prolong life, such as dialysis. This article addresses the key considerations of supportive care as part of integrated end-stage kidney disease care, with particular attention paid to programs in low- and middle-income countries. Supportive care should be an integrated component of care for patients with advanced chronic kidney disease, patients receiving kidney replacement therapy (KRT), and patients receiving non-KRT conservative care. Five themes are identified: improving information on prognosis and support, developing context-specific evidence, establishing appropriate metrics for monitoring care, clearly communicating the role of supportive care, and integrating supportive care into existing health care infrastructures. This report explores some general aspects of these 5 domains, before exploring their consequences in 4 health care situations/settings: in people approaching end-stage kidney disease in high-income countries and in low- and middle-income countries, and in people discontinuing KRT in high-income countries and in low- and middle-income countries.

We want to take up the challenge posed by Nadar and cols. in their May editorial about managing hypertension during the COVID-19 pandemic [1]. Their concern that patients with chronic illnesses would be forgotten in the fight against the paradigm of a transmissible virus and result in collateral damage reached the public domain since June [2]. In mid October the number of new confirmed cases is still increasing in the Americas, South-East Asia and Europe according to the World Health Organization [3]; lockdowns have been reinstalled in various zones and widely available vaccines are far from around the corner. In the present situation it is urgent to mitigate the collision of non-transmissible conditions with the rapid spread of the novel COVID infection by new patterns of interaction between all the protagonists involved in health care.

Prevention and early detection of kidney diseases in adults and children should be a priority for any government health department. This is particularly pertinent in the low-middle-income countries, mostly in Asia, Africa, Latin America, and the Caribbean, where up to 7 million people die because of lack of end-stage kidney disease treatment. The nephrology workforce (nurses, technicians, and doctors) is limited in these countries and expanding the size and expertise of the workforce is essential to permit expansion of treatment for both chronic kidney disease and end-stage kidney disease. To achieve this will require sustained action and commitment from governments, academic medical centers, local nephrology societies, and the international nephrology community.