BACKGROUND:Establishing a comprehensive apheresis medicine program in a resource-constrained setting presents significant structural, financial, and logistical challenges. Despite the growing clinical importance of apheresis services globally, published experience from sub-Saharan Africa remains sparse. This study describes the 5-year operational experience of building and sustaining an Apheresis Medicine program at Next Hematology Medicare, a private hematology center in Lagos, Nigeria, including the challenges encountered, solutions implemented, and clinical outcomes achieved. METHODS:A retrospective review of all apheresis procedures performed between May 2020 and December 2025 was conducted. Therapeutic apheresis procedures included automated red cell exchange transfusion (RCE), therapeutic plasma exchange (TPE) and leukocytapheresis. Donor apheresis procedures comprised single-donor apheresis platelet collections for transfusion and stem cell collection (SCC) by donors. Data on patient demographics, clinical indications, procedural outcomes, and geographic distribution of platelet delivery were collected and analyzed. RESULTS:A total of 2405 apheresis procedures were performed over the 5-year period. Donor apheresis platelet (AP) collection was the most frequently performed procedure (n = 1772; 73.7%), followed by RCE (n = 617; 25.7%) as the most common therapeutic apheresis modality. TPE accounted for 12 procedures (n = 12; 0.5%), while leukocytapheresis (n = 2; < 0.1%) and SCC (n = 1; < 0.1%) were performed infrequently. For AP, Sepsis/DIC was the leading transfusion indication (n = 968; 54.6%). RCE was performed predominantly for patients with sickle cell anemia (SCA), with intractable recurrent vaso-occlusive crises (VOC) being the most common indication (n = 382; 61.9%). RCE significantly reduced hemoglobin S (HbS%) from 93.13% ± 12.4% to 18.74% ± 4.2% (p < 0.001) and improved hematocrit from 16.34% ± 3.5% to 26.01% ± 4.2% (p < 0.001). TPE was primarily indicated for neurological and transplant-related conditions. Apheresis platelets were distributed nationally across all six geopolitical zones and internationally. CONCLUSION:A fully functional Apheresis Medicine program can be successfully established and sustained in a resource-constrained low- and middle-income country (LMIC) setting, delivering outcomes comparable to high-income country benchmarks. RCE showed significant hematological benefits for patients with SCA, and donor apheresis platelet delivery extended care across all Nigerian geopolitical zones. The operational framework described here, addressing funding, infrastructure, staffing, licensing, and blood safety, provides a possibly replicable model for Apheresis Medicine program development across sub-Saharan Africa.

Therapeutic plasma exchange (TPE) is essential for kidney transplant desensitization and management of immune-mediated disorders, yet access remains limited across sub-Saharan Africa due to infrastructure, workforce, and supply chain constraints. While clinical efficacy is well established, there is limited literature describing how such programs can be successfully implemented in resource-constrained environments. This study describes the systematic development, implementation, and operational outcomes of a sustainable TPE program in Nigeria, with emphasis on practical strategies for replication. We conducted a mixed-methods evaluation combining program development analysis (2017-2023) with retrospective clinical data review of all TPE procedures performed between January 2020 and December 2022. Key domains analyzed included infrastructure development, equipment procurement, staff training, protocol adaptation, quality assurance systems, cost structure, and operational challenges. Clinical outcomes included utilization patterns and safety metrics. Program establishment required approximately 24 months and an initial capital investment of $148 000 USD. A total of 150 TPE sessions were performed in 90 patients. The predominant indication was pretransplant desensitization, followed by antibody-mediated rejection, T-cell mediated rejection, and Guillain-Barré syndrome. Procedure-related complications occurred in 2% of sessions and were uniformly mild and reversible, with no mortality. Direct cost per procedure decreased from $685 in 2020 to $550 in 2022, achieving financial sustainability by the third year of operation. Key operational challenges included supply chain delays, power instability, and workforce retention, which were mitigated through structured adaptations including long-term inventory planning, infrastructure redundancy, and staff development strategies. TPE programs can be safely and sustainably established in resource-constrained settings through structured planning, context-specific adaptations, and investment in local capacity building. Transplant outcomes were not analyzed in this study period. This experience provides a practical and replicable framework for expanding access to apheresis services in similar environments.

Background:Data on the epidemiology of acute kidney injury (AKI) in adults hospitalized with Lassa fever is limited. We investigated the rates and predictors of AKI and in-hospital mortality at a National Treatment Centre in Southwest Nigeria. Methods:This retrospective study included 482 adults with RT-PCR-confirmed Lassa fever admitted to the Federal Medical Centre, Owo, Ondo State, Nigeria, from January 2019 to December 2024. Predictors of AKI and in-hospital mortality were identified by multivariable logistic regression and Cox proportional hazards regression analyses. Results:Acute kidney injury prevalence was 21% (95% CI, 17.4%-24.9%). Overall, 48 patients (10.1%) died: 33 (32.7%) with AKI and 15 (4.0%) without AKI (OR 11.647; 95% CI, 6.001-22.604; P < .001). Independent predictors of AKI included male sex (P < .001), bleeding abnormalities (P = .044), diabetes (P = .029), elevated white blood cell count (P = .005), increased neutrophil count (P = .003), and elevated aspartate transaminase (P = .017). Predictors of in-hospital mortality were AKI (P = .033), oliguria (P = .045), mean arterial blood pressure (P = .001), hematuria (P = .015), and elevated monocyte count (P = .022). Kaplan-Meier analysis demonstrated significantly poorer survival in patients with AKI versus those without (mean survival 19.0 vs 29.7 days; P ≤ .001). Conclusions:Acute kidney injury complicates approximately one-fifth of RT-PCR-confirmed Lassa fever hospitalizations and is associated with an 11-fold increase in mortality. Male sex, bleeding, diabetes, leukocytosis, and elevated aspartate transaminase independently predict AKI, while oliguria, hematuria, blood pressure, and monocyte count predict death.

BACKGROUND:Therapeutic apheresis (TA) is an established treatment modality for hematologic, neurologic, and immunologic disorders, yet access remains severely limited in sub-Saharan Africa. Donor apheresis, including platelet apheresis collection from healthy donors, represents an important complementary modality supporting blood product availability and national transfusion services. The Nigerian Society for Apheresis (NSFA) held its inaugural scientific meeting on February 6, 2026, representing a significant milestone in advancing apheresis services in West Africa. METHODS:We present a comprehensive summary of seven oral presentations and three poster abstracts submitted to the inaugural NSFA meeting, representing multi-center experiences from Lagos, southeastern Nigeria, and international collaborative programs. RESULTS:Collectively, over 3800 therapeutic and donor apheresis procedures were reported across multiple centers over varying time periods. The most common procedures were apheresis platelets (73.7% of 2405 procedures at one center) and automated red cell exchange for sickle cell disease (25.7%). Therapeutic plasma exchange (TPE) was performed for neurological indications including Guillain-Barré syndrome, myasthenia gravis, and neuromyelitis optica, as well as for renal transplant desensitization. A national survey revealed limited awareness among healthcare workers (mean knowledge score 5.10 ± 2.44/10), yet 88.4% expressed interest in hands-on training. International collaboration through the ISN Sister Renal Centers program successfully established TPE capabilities at two centers in southwestern Nigeria. Common challenges included equipment availability, consumables supply, and cost barriers. CONCLUSIONS:These abstracts demonstrate growing therapeutic and donor apheresis capacity in Nigeria despite significant infrastructural and economic challenges. The establishment of NSFA and collaborative international programs represents a critical step toward expanding access to this essential therapy in West Africa.

Apheresis medicine comprises a group of extracorporeal therapies essential for the management of hematologic, renal, neurologic, immunologic, transplant-related, oncologic, and critical care conditions. Advances in technology, expansion of evidence-based indications, and integration into multidisciplinary care pathways have transformed apheresis from a technical service into a clinically complex subspecialty. We conducted a narrative review of published literature and international society documentation describing models for apheresis training, professional societies, quality assurance, and regulatory interaction across high-income and resource-limited settings. Sources included peer-reviewed literature, international society guidelines, and policy documents published primarily between 2010 and 2026. Professional apheresis societies have emerged internationally to support education, quality assurance, guideline development, and workforce competency, frequently in collaboration with regulatory authorities. These societies function as scientific and educational bodies complementary to, rather than substitutive of, regulatory frameworks. Six core domains of society activity were identified: education and continuing professional development (CPD), quality and patient safety, guidelines and standards, workforce development, research and registries, and professional collaboration. Apheresis medicine has matured into a multidisciplinary clinical subspecialty requiring a dedicated professional infrastructure. International experience demonstrates that professional apheresis societies provide an evidence-based mechanism to advance education, quality assurance, and patient safety while complementing regulatory oversight. These models are generalizable across healthcare systems at varying stages of development.

INTRODUCTION:The use of therapeutic apheresis (TA) either as stand-alone or adjunctive treatment in kidney transplantation has increased over the years to become a leading indication. This study shows recent trends in indications for TA related to kidney transplantation, adverse events, and patient outcome in this cohort.METHODS:This is a retrospective cohort review of adults who received TA for kidney transplant-related indications from January 1, 2017, to December 31, 2022, at the University of Virginia Medical Centre, Charlottesville, VA, USA. Data extracted include basic demographics, indication for apheresis, number of procedures, procedure characteristics, procedure-related adverse events (complications), and serum ionized calcium and serum creatinine. Data were analyzed using statistical package for social sciences (SPSS 2022 IBM Inc).RESULTS:Data from a total of 131 patients who received 860 TA procedures were analyzed. Indications for TA were antibody-mediated rejection (65.5%), recurrent focal segmental glomerulosclerosis (15%), thrombotic microangiopathy (5%), desensitization for ABO incompatibility (4.5%) and for HLA-incompatibility (4.5%), and recurrent IgA nephropathy (1%). Some adverse events were encountered in 16.7% of the procedures and include hypocalcemia (7%), vascular access malfunction (0.7%), hypotension (1.2%), arrhythmia (0.6%), and depletion coagulopathy (0.6%). The overall case mortality rate was 8.4% over the 6-year period. There was one death recorded on machine during TA resulting in a procedure-mortality rate of 0.12%.CONCLUSION:Antibody-mediated rejection was the most common indication for TA related to kidney transplantation. Adverse events were minor and patient survival over the time was within usual limits.

Apheresis is performed worldwide for an increasing number of indications. The development of common data elements (CDE) for apheresis related areas may facilitate conduct of new research, enhance quality initiatives including benchmarking, and improve patient care. This report describes the systematic development of the Uniform Apheresis Case Report Form (UACRF) as part of the Apheresis in the United States (ApheresUS) program. A consensus panel of 17 diverse experts in apheresis, related specialties, and electronic case report form (eCRF), and database development was assembled. The panel met via online conferencing from November 17, 2020 to December 1, 2021. A draft document was posted online for public comment from October 11, 2021 to November 10, 2021. Feedback was collected using an online survey tool. The consensus panel revised the UACRF. This version was converted to an eCRF with additional changes made to improve usability in this format. The final version of the UACRF was created on August 24, 2023. The UACRF contains 16 modules: procedure and subject eligibility, patient demographics, general procedure information, laboratory parameters, vascular access, common procedure elements, eight procedure specific modules (mononuclear cell collection and seven therapeutic modalities), outcomes, and site information. A total of 137 data elements were created, including 57 with one or more subelements. The UACRF is the first systematic attempt to develop CDE for therapeutic apheresis and white blood cell collections. Further validation of the UACRF is necessary to confirm the tool's ability to collect the relevant data elements and determine the usability of the form.

IntroductionThe increase in the number of kidney transplants performed in the United States has been paralleled with an increase in the utilization of therapeutic apheresis (TA) for kidney transplant indications. Hypocalcemia remains a significant contributor to the adverse event in TA. The magnitude of hypocalcemia and its risk factors are scarcely discussed in literature.MethodsThis is a retrospective cohort review of adults from 18 years and above who received TA for kidney transplant-related indications from January 1, 2017 to December 31, 2022. Data extracted included basic demographics, indication for apheresis, procedure characteristics, serum ionized calcium at the mid and end of procedure and serum creatinine at the beginning of apheresis, and so forth.ResultsData from 131 patients and 860 sessions of TA were analyzed. Antibody-mediated rejection (69%) and recurrent FSGS (15%) were the leading indications for TA. There were 60 (7%) TA sessions complicated by hypocalcemia. Of these, 53 (88%) occurred in the first session, 5 (8%) occurred in second session while 2 (4%) occurred in the third and subsequent sessions. Female sex, elevated serum creatinine and use of fresh frozen plasma- are the risk factors for hypocalcemia with odd's ratio of 2.34, 7.42, and 5.01, respectively. Binary logistic regression showed that elevated serum creatinine at the commencement of therapy is an independent predictor of hypocalcemia (adjusted odd's ratio = 3.31, p = 0.001).ConclusionHypocalcemia is prevalent in this study. Clinical vigilance and tailored procedure will avert adverse consequences.

Racial disparities in incidence and outcomes of acute kidney injury (AKI) are pervasive and are driven in part by social inequities and other factors. It is well-documented that Black patients face higher risk of AKI and seemingly have a survival advantage compared to White counterparts. Various explanations have been advanced and suggested to account for this, including differences in susceptibility to kidney injury, severity of illness, and socioeconomic factors. In this review, we try to understand and further explore the link between race and AKI using the incidence, diagnosis, and management of AKI to illustrate how race is directly related to AKI outcomes, with a focus on Black and White individuals with AKI. In particular, we explore the effect of race-adjusted estimated glomerular filtration rate (eGFR) equation on AKI prediction and discuss racial disparities in the management of AKI and how this might contribute to racial differences in AKI-related mortality among Blacks with AKI. We also identify some opportunities for future research and advocacy.

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa reported zero co-payment for all modalities of kidney replacement therapy in the public sector. Policies on chronic kidney disease and non-communicable diseases were scarcely available across all African sub-regions. The ISN–GKHA African data highlight a stark difference in kidney care measures between North and sub-Saharan Africa and also suggest the need for a more cohesive approach to policy formulations that support and protect patients with kidney disease in the continent, especially from the excessive costs associated with care. Using the World Health Organization (WHO) Global Action Plan for noncommunicable diseases, this paper proposes an African roadmap for optimal kidney care.

Introduction: Acute kidney injury (AKI) is known to be associated with increased mortality, and racial differences in hospital mortality exist in patients with AKI. However, it remains to be seen whether racial differences exist in post-hospitalization mortality among AKI patients. Methods: We analyzed data of adult AKI patients admitted to the University of Virginia Medical Center between January 1, 2001, and December 31, 2015, to compare in-hospital and post-hospitalization mortality among hospitalized black and white patients with AKI. Multivariable logistic regression analysis was used to analyze the association between race and in-hospital mortality, and 90-day post-hospitalization mortality among AKI patients that were discharged. Kaplan-Meier survival curve was used to evaluate long-term survival between black and white patients. Results: Black patients had lower in-hospital mortality than white patients after adjusting for age, sex, estimated glomerular filtration rate, hospital length of stay, severity of AKI, comorbidities, and the need for dialysis and mechanical ventilation (odds ratio: 0.82; 95% confidence interval, 0.70–0.96, p = 0.0015). Similarly, at 90-day post-hospitalization, black patients had significantly lower adjusted odds of death than white patients (odds ratio: 0.64; 95% confidence interval, 0.46–0.93; p = 0.008). The median length of follow-up was 11.9 months (0.6–46.7 months). Kaplan-Meier survival curve showed that long-term survival was significantly better in black patients compared to white patients (median duration of survival; 39.7 vs. 24.8 months; p ≤ 0.001). Conclusions: Black patients with AKI had lower in-hospital mortality, 90-day post-hospitalization mortality, and better long-term survival rates compared to white patients with AKI.

Therapeutic plasma exchange (TPE) is frequently the most common Apheresis Medicine technique used for extracorporeal therapy of a wide variety of renal, neurological, hematological, and other clinical indications. Many of these clinical indications require intensive care during critical illness. Conventional TPE uses one of two main technical methods to achieve the goal of removing known disease mediators from the plasma: using centrifugal forces to separate and remove components of blood, or a membrane filtration method that separates plasma from the cellular components of blood. The following review discusses the basic principles of TPE, the technological aspects, and relevant clinical scenarios encountered in the intensive care unit, including relevant guidelines and recommendations from the American Society for Apheresis.

Oladipo Olujimi Akinkugbe, fondly referred to as “Prof” by multiple generations of medical professionals, and by society as a whole, passed away peacefully in Ibadan, Nigeria, on Monday, June 15, 2020. He was an Emeritus Professor of Medicine at University of Ibadan, and over the years, a Rockefeller Visiting Fellow (Johns Hopkins, Yale, Washington), a Fellow of Balliol College University of Oxford, and a Visiting Professor at Harvard University. Professor Akinkugbe was born in Ondo, a historic city in southwestern Nigeria on July 17, 1933. He attended Government College, Ibadan, Nigeria, and did his medical school preclinical years at University College, Ibadan, and his clinical years at the Royal London Hospital. His medical degree was awarded by the University of London in 1958. He also gained a diploma in Tropical Medicine and Hygiene from the University of Liverpool, United Kingdom, in 1960. He obtained his Doctor of Philosophy at the University of Oxford, where he studied the role of angiotensin in hypertension in 1962 to 1964. In 1965, he returned to Nigeria to become Professor of Medicine and Dean of the Faculty of Medicine (1970–1974). He was a Fellow of the Royal College of Physicians of Edinburgh, the Royal College of Physicians of London, the National Postgraduate Medical College of Nigeria, and the West African College of Physicians. At various times he was a visiting Fellow or visiting Professor at several prominent institutions in the United States (John Hopkins, Yale, Washington, Seattle Medical School, Harvard), the United Kingdom (Oxford), and South Africa (Cape Town). He was also Secretary to the World Health Organization (WHO) Technical Discussions on Universities and Health for All, Geneva (1983–1984), and member of the WHO Advisory Committee on Health for Research (1990–1994). Professor Akinkugbe is best known for his pioneering work in the specialty of hypertension and nephrology, not only in Nigeria, the country with the highest population of black Africans in the world, but also across Africa. In one of the earliest studies of hypertension in Africa,1Akinkugbe O.O. Ojo O.A. Arterial pressures in rural and urban populations in Nigeria.Br Med J. 1969; 2: 222-224Crossref PubMed Scopus (52) Google Scholar he reported on the various phenotypes associated with hypertension in indigenous black Africans, including urban and rural differences in hypertension prevalence. He made significant contributions to the medical literature on kidney disease and hypertension. In addition, he pioneered the use of acute peritoneal dialysis for patients with acute kidney injury in Nigeria in the mid-1960s, well before hemodialysis became readily available in the continent. Professor Akinkugbe was Principal and Foundation Vice-Chancellor of the University of Ilorin, and at different times Vice-Chancellor of Ahmadu Bello University, Zaria, Pro-Chancellor of the University of Port Harcourt, Chairman of the Management Board of University College Hospital, Ibadan, and Chairman of the Planning Committees of Ondo State University and University of Abuja. He embraced these roles with an eagerness to improve the quality of health care, research, and medical education, having argued for governments to establish and provide more support for teaching hospitals in developing countries.2Akinkugbe O.O. Role of teaching hospitals in a developing country.Br Med J. 1973; 1: 474-476Crossref PubMed Scopus (2) Google Scholar Professor Akinkugbe trained the first generation of indigenous nephrologists in Nigeria, many of whom have now become leading figures in nephrology. He also mentored several nephrologists from the West African region. He established the Nigerian Association of Nephrology with a few other colleagues in 1987, an association that has now grown to over 400 members and is one of the strongest in Africa. He was the Foundation President of the Nigerian Association of Nephrology and Nigerian Hypertension Society and was also a foundation member of the African Association of Nephrology. Professor Akinkugbe received the 2019 International Society of Nephrology’s Pioneer Award, which was conferred to him on 18 February 2020 in Ibadan, Nigeria. He is survived by Professor Mrs. F.M. Akinkugbe (an icon at University of Ibadan in her own right), their two children, and grandchildren. In memoriam: Jacob Plange-Rhule, MB, ChB, PhD, FGCP, FWACP, FRCP (1957–2020)Kidney InternationalVol. 98Issue 4PreviewProfessor Jacob Plange-Rhule was the Rector of the Ghana College of Physicians and Surgeons, a nephrologist at Komfo Anokye Teaching Hospital and a professor at the Kwame Nkrumah University of Science and Technology in Kumasi. Dr. Plange-Rhule died at the age of 62 on Good Friday, April 10, 2020. Dr. Plange-Rhule was born on July 27, 1957, in Elmina in Ghana. He trained in medicine at the Kwame Nkrumah University of Science and Technology in Kumasi, qualifying in 1984. Dr. Plange-Rhule met his wife Gyikua in medical school, and they married in 1987. Full-Text PDF Nephrology in Africa: forgotten no moreKidney InternationalVol. 98Issue 4PreviewDuring a time when the world is grappling with the coronavirus disease 2019 pandemic, African nephrology suffered a major setback, with the passing of 3 of its stalwarts: Oladipo Akinkugke (Nigeria), Jacob Plange-Rhule (Ghana)—whose obituaries are featured in this issue—and Mohamed Abdullah (Kenya). These individuals bookend the period during which nephrology took roots in the continent. This editorial discusses the highlights of African nephrology during this development phase and recalls some of the individuals who made them possible. Full-Text PDF

Background: Despite evidence that advance care planning (ACP) benefits patients with serious illnesses, there is a dearth of information about "who" is referred for palliative care (PC) consultation, the rate of PC consultation, and the outcomes of referrals in patients with advanced chronic kidney disease/end-stage kidney disease (aCKD/ESKD). Objectives: (1) To describe patient characteristics associated with PC consultations and (2) to determine the frequency and outcome of PC consultation on documented ACP discussions for patients with aCKD/ESKD. Methodology/Design: This is retrospective observational electronic health record cohort review. Settings: University of Virginia (UVA) hospital, clinics, and dialysis units. Participants: Patients were studied along two time intervals. Time period January 1, 2015 to June 30, 2017 included all patients admitted to UVA during that time period with estimated glomerular filtration rate (eGFR) <60 mL/minute. Time period January 1, 2018 to March 31, 2019 included two cohorts: patients with eGFR <15 mL/minute who had died during study period excluding those who withdrew from dialysis and those who were dialysis dependent and withdrew from dialysis. Results: Aside from higher rates of PC consultation in patients with heart failure, none of the demographic and comorbidity data studied affected whether or not a patient is referred to PC in patients with aCKD/ESKD. PC consultation rates were low among all patients studied: 14.7% in patients with eGFR <60 mL/minute, 28.9% in dialysis patients withdrawing from dialysis, and 57.1% in terminally ill patients with eGFR <15 mL/minute. In all cohorts, PC consultations were associated with improved ACP. Conclusion: PC consultation is significantly associated with better end-of-life outcomes with more completion of ACP and hospice referral in patients with aCKD/ESKD. PC consultation rates remain low. Even in terminally ill patients with more aCKD, >40% were never seen by PC. Until policies and curricula better prepare nephrologists to independently address ACP, collaboration between nephrologists and PC specialists is recommended.