Secular increases in the burden of kidney failure is a major challenge for health systems worldwide, especially in low- and middle-income countries (LMICs) due to growing demand for expensive kidney replacement therapies. In LMICs with limited resources, the priority of providing kidney replacement therapies must be weighed against the prevention and treatment of chronic kidney disease, other kidney disorders such as acute kidney injury, and other noncommunicable diseases, as well as other urgent public health needs. Kidney failure is potentially preventable—not just through primary prevention of risk factors for kidney disease such as hypertension and diabetes, but also by timely management of established chronic kidney disease. Among people with established or incipient kidney failure, there are 3 key treatment strategies—conservative care, kidney transplantation, and dialysis—each of which has its own benefits. Joining up preventive care for people with or at risk for milder forms of chronic kidney disease with all 3 therapies for kidney failure (and developing synergistic links between the different treatment options) is termed “integrated kidney care” and has potential benefits for patients, families, and providers. In addition, because integrated kidney care implicitly considers resource use, it should facilitate a more sustainable approach to managing kidney failure than providing one or more of its components separately. There is currently no agreed framework that LMIC governments can use to establish and/or scale up programs to prevent and treat kidney failure or join up these programs to provide integrated kidney care. This review presents a suggested framework for establishing integrated kidney care programs, focusing on the anticipated needs of policy makers in LMICs.

长期以来，肾衰竭负担的增加是全球卫生系统的一项主要挑战，特别是在中低收入国家（LMIC）中，因为对昂贵的肾脏替代疗法的需求不断增长。在资源有限的中低收入国家中，必须优先考虑提供肾脏替代疗法，而不是预防和治疗慢性肾脏疾病，其他肾脏疾病，例如急性肾脏损伤和其他非传染性疾病，以及其他紧急公共卫生需求。肾脏衰竭是可以预防的-不仅可以通过预防高血压和糖尿病等肾脏疾病的危险因素，而且可以通过及时治疗已建立的慢性肾脏疾病来预防。在患有肾病或初发肾功能衰竭的人群中，有3种主要的治疗策略：保守治疗，肾脏移植和透析-每种方法都有其自身的优势。对所有患有肾衰竭的三种疗法（以及在不同治疗方案之间建立起协同作用的疗法）联合针对患有轻度慢性肾脏病或有轻度慢性肾脏病风险的人提供预防性护理，被称为“综合性肾脏护理”，对患者，家庭有潜在的好处，以及提供者。此外，由于综合性肾脏护理隐含地考虑了资源的使用，因此与单独提供一个或多个成分相比，它应该有助于采用一种更具可持续性的方法来管理肾脏衰竭。LMIC政府目前尚无商定的框架可用于建立和/或扩大预防和治疗肾衰竭的计划，或加入这些计划以提供综合的肾脏护理。