Research 1 – Barriers to Implementing Environmentally
Sustainable Kidney Care

A health system comprises several levels and we stratified
barriers by patient level, provider level, and system level
(Figure 2).

Patient-Level Barriers

Poor and inequitable access to health care: All participants
report the lack of universal health care as the most critical
barrier to implementing ESKC. Sustainability is not a priority
for patients when most cannot afford medications, trans-
plantation, or dialysis, such as in Uganda, where 90% of
patients in need of kidney replacement therapy cannot afford
it.26 In addition, access to care is inequitable as most dialysis
and transplant programs are located in urban centers,14,20 and
many patients incur substantial out-of-pocket expenses
(Table 1).

Poor appreciation of preventative approaches and delay in seek-
ing care. Lack of awareness of CKD and delay in seeking
care is another critical barrier. In Nigeria, for instance,
patients either live in denial of disease even with overt symptoms or consider it as “the will of God” and thus resort to
faith-based healing practices or use of herbal concoctions.
Thus, many present with uremic symptoms limiting opportunities
to initiate early treatments to prevent CKD progression.
It is well recognized that the carbon footprint of kidney
care increases with increasing CKD stages.3,6 Also, patients
are largely unaware of the risk factors for CKD, such as diabetes.
Similarly, India is called the diabetes capital of the
world.27 Increasing obesity, sedentary lifestyle, cost of
healthy food choices, and increased consumption of cheaper
high-carbohydrate diets contribute to the burden of diabetes
and CKD.




TY  – JOUR
AU  – Bajpai, Divya
AU  – Hailu, Workagegnehu
AU  – Bagasha, Peace
AU  – Onu, Ugochi
AU  – Hafiz, Ehab
AU  – Tannor, Elliot
AU  – Wijewickrama, Eranga
AU  – Kalyesubula, Robert
AU  – Karam, Sabine
AU  – Calice-Silva, Viviane
AU  – Ethier, Isabelle
AU  – Sandal, Shaifali
PY  – 2024/05/20
SP  – 20543581241246835
T1  – Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece
VL  – 11
DO  – 10.1177/20543581241246835
JO  – Canadian journal of kidney health and disease
ER  – 

https://www.researchgate.net/publication/380783267_Challenges_to_Implementing_Environmentally_Sustainable_Kidney_Care_in_LMICs_An_Opinion_Piece