The rise and rise of randomized clinical evidence in Sub-Saharan Africa

Abstract

Sub-Saharan Africa is facing a rising tide of chronic disease, including chronic kidney disease, but the current research literature provides little evidence to guide the practice of nephrology in resource-poor settings. In this issue of CKJ, Waziri & Bello present a trial of two formulations of intravenous iron for patients with anaemia of chronic kidney disease in Nigeria. This study typifies a growing body of work from researchers from low-middle income countries addressing the evidence gaps that they meet in their everyday practice. Collaboration with clinical trialists and health economists from the global renal research community is suggested as an important way to expand, at low cost, the randomized evidence-base in this region.

Inequities in the global representation of sites participating in large, multicentre dialysis trials: a systematic review

“…Furthermore, co-morbid illnesses differ, with a greater prevalence of some infectious diseases, such as hepatitis and tuberculosis, complicating the management of patients with ESKD 6. Finally, many low-income and middle-income countries are facing a rising burden of non-communicable diseases in the presence of a continued need to invest scarce healthcare resources combatting persistently high rates of communicable diseases 2. As a result, ESKD may be accorded relatively lower research priority.…”

“…These differences ought to be reflected in the available clinical evidence as therapies proven to work in one context may be unavailable, or less effective, in another. Moreover, while many aspects of dialysis therapy and evidence are universally relevant, many clinical questions differ in importance to patients, clinicians and healthcare providers, depending on their location, available resources and context 2…”

“…Such trials are, therefore, critically important to clinicians, healthcare providers and health economists when making patient treatment and resource-allocation decisions. Unfortunately, despite rapid growth in the burden of non-communicable diseases, the output of RCTs from low-income and middle-income countries is believed to be meagre 2. There has, however, been little formal study of this issue in nephrology.…”