Background The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. Methods This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. Results Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. Conclusion Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.

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Chronic kidney disease (CKD) is increasingly diagnosed and thus more patients are in need of hemodialysis (HD) to sustain their life. The quality of vascular access for HD should be suitable for repeated puncture and allow a fast blood flow rate for high-efficiency dialysis with minimal complications. Our study aimed to document local experience and early outcomes after arteriovenous fistula (AVF) creation for hemodialysis access including complications related to AVF creation.This was a hospital based clinical audit in which case notes of patients who had undergone AVF creation between May, 2017 and March, 2018 at Muhimbili National Hospital (MNH) were reviewed using a structured data collection tool. Information regarding preoperative assessment for AVF creation, outcome of AVF, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables. A total of 57 case notes of patients who underwent AVF creation for HD access with males contributing majority of patients (77.2%) were reviewed. The predominant age group was 41 to 60 years of age (56.2%) with mean age 47 years and age range of 18 -69 years. Three patients had procedure abandoned on the table due to sclerotic vein. The functional maturation rate was found to be 64.9% and post AVF complications in 15 patients (26.3%). Recorded post AVF creation complications were fistula stenosis/revision (27.8%), bleeding/haematoma (22.2%), limb oedema (22.2%), aneurysm (11.1%), surgical site infection [SSI] (11.1%) and thrombus formation (5.6%).AVF creation for HD access is common at MNH with a functional maturation rate of 64.9%, which is an acceptable rate. The preoperative vascular assessment in this survey was mainly found to be physical examination while preoperative vascular imaging was not commonly done to assess suitability of veins and arteries for AVF creation although post AVF complications are relatively few.

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