Delivery of Chronic Kidney Disease Care by Non-Nephrologist Physicians in Low-Income Countries: A Multicenter Study from Tanzania

 

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Delivery of Chronic Kidney Disease Care by Non-Nephrologist Physicians in Low-Income Countries: A Multicenter Study from Tanzania

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vincent
Mboya
vincent Mboya vnivox1200@gmail.com Amana Regional Referral Hospital Internal Medicine dar es salaam Tanzania *
Robert Magoma robmagoma@gmail.com Amana Regional Referral Hospital Internal Medicine dar es salaam Tanzania -
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Chronic kidney disease (CKD) is an emerging public health challenge in low- and middle-income countries (LMICs), contributing to high morbidity, mortality, and catastrophic healthcare costs. Limited numbers of nephrologists in these regions result in most CKD patients being managed by non-nephrologist physicians. This study evaluated the level of nephrological care delivered by non-nephrologist physicians in Tanzania.

A multicenter, cross-sectional study was conducted among 360 non-nephrologist physicians practicing in primary, secondary, and tertiary healthcare facilities across Tanzania Mainland. A 32-item online self-administered questionnaire, based on the KDIGO 2012 CKD Clinical Practice Guidelines, was used to assess physicians’ knowledge, screening practices, and management of CKD.

 Primary outcome: Physicians’ adherence to evidence-based CKD detection and management practices.

Secondary outcome: Differences in CKD-care practices across facility levels.

A total of 362 physicians completed the survey; 309 (85.4%) reported having managed patients with CKD in the preceding 12 months. Most respondents routinely screened patients with hypertension and diabetes for CKD. However, nearly half did not screen individuals with hepatitis B or C, malignancy, HIV, tuberculosis, autoimmune disorders, or advanced age. Only a minority prescribed ACE inhibitors or ARBs, and one-third routinely advised dietary protein restriction. Adherence to CKD guidelines did not significantly differ between physicians working in primary, secondary, or tertiary facilities.

Adherence to CKD clinical practice guidelines among non-nephrologist physicians in Tanzania is suboptimal. Important risk groups—including the elderly and patients with chronic infections, malignancy, or autoimmune disease—are frequently under-screened. The use of evidence-based therapies such as ACE inhibitors/ARBs remains low. There was no observed difference in CKD-care practices across facility levels.

To strengthen CKD management, national CKD-care campaigns should be integrated into Tanzania’s health system—similar to established programs for HIV, tuberculosis, diabetes, and hypertension—to promote awareness, screening, and guideline adoption among non-nephrologist physicians.

Kewords