The Overlooked Burden of Chronic Kidney Disease in African Intensive Care Units: A Call for Standardized Renal Surveillance

Abstract

Introduction: Chronic kidney disease (CKD) is a growing threat to public health in sub-Saharan Africa, yet it is not reliably monitored in the intensive care unit (ICU), where acute kidney injury is often the silent precursor to CKD. Methods: Drawing on data from a prospective cohort of 848 adults admitted to a multidisciplinary ICU in South Africa in 2017 (Aylward, 2019), this commentary argues that many African ICUs lack the standardized renal surveillance needed to identify the transition. A multivariate logistic regression analysis of the cohort identified age and peak serum creatinine as statistically significant predictors of CKD (p <.0001), while gender and race were not statistically significant (p >.05).  By reviewing regional literature on CKD epidemiology, health-system capacity and the AKI-to-CKD transition, the paper argues that clinical variables rather than demographic factors should form the basis of CKD risk stratification in critical care, and that the region's fractured renal data infrastructure leaves this risk largely invisible to clinicians and policymakers. The paper concludes by outlining a policy framework for standardized, KDIGO-aligned renal surveillance in African ICUs, based on 6-monthly creatinine monitoring, structured post-discharge follow-up and alignment with national CKD registries.