the setting up of teams to provide integrated care (36). In Cuba, the Ministry of Public Health has implemented a national program for the prevention of CKD. Since 1996 the program has followed several steps: 1) the analysis of the resources and health situation in the country; 2) epidemiological research to define the burden of CKD; and 3); continuing education for nephrologists, family doctors, and other health professionals. The main goal has been to bring nephrology care closer to the community through a regional redistribution of nephrology services and joint management of CKD patients by primary healthcare physicians and nephrologists (37). The integration of CKD prevention into NCDs program has resulted in the reduction of renal and cardiovascular risks in the general population. Main outcomes have been the reduction in the prevalence of risk factors, such as low birth weight, smoking, and infectious diseases. There has been an increased rate of the diagnosis of diabetes and of glycemic control, as well as an increased diagnosis of patients with hypertension, higher prescription use of renoprotective treatment with ACEI, and higher rates of blood pressure control (38). Recently, the US Department of Health and Human Services has introduced an ambitious program to reduce the number of Americans developing ESRD by 25 percent by 2030. The program, known as the Advancing American Kidney Health Initiative, has set goals with metrics to measure its success; among them is to increase efforts to prevent, detect, and slow the progression of kidney disease, in part by addressing traditional risk factors like diabetes and hypertension. To reduce the risk of kidney failure, the program contemplates advancing public health surveillance and research to identify populations at risk and those in early stages of kidney disease, and to encourage adoption of evidence-based interventions to delay or stop progression to kidney failure (39). Ongoing programs, like the Special Diabetes Program for Indians represents an important part of this approach by providing team-based care and care management. Since its implementation, the incidence of diabetes-related kidney failure among American Native populations decreased by over 40 percent between 2000 and 2015 (40). Involvement of primary care physicians and other health professionals Detection and prevention of CKD programs require considerable resources both in terms of manpower and funds. Availability of such resources will depend primarily on the leadership of nephrologists (41). However, the number of nephrologists is not sufficient to provide renal care to the growing number of CKD patients worldwide. It has been suggested that most cases of non-progressive chronic kidney disease can be managed without referral to a nephrologist, and specialist referral can be reserved for patients with an estimated GFR rate o30 mL min–1 (1.73 m2 ) –1 , rapidly declining kidney function, persistent proteinuria, or uncontrolled hypertension or diabetes (42). It has been demonstrated that with an educational intervention the clinical competence of family physicians increases, resulting in preserved renal function in diabetic patients with early renal disease (43). The practitioners who received the educational intervention used significantly more angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and statins than did practitioners who did not receive it. The results were similar to those found in patients treated by nephrologists (44). The role of primary health care professionals in the implementation of CKD prevention strategies in LMIC has been recently illustrated (45). The e-learning has become an increasingly popular approach to medical education. Online learning programs for NCD prevention and treatment, including CKD, have Braz J Med Biol Res | doi: 10.1590/1414-431X20209614 Prevention of kidney diseases 6/10 been successfully implemented in Mexico. By 2015, over 5000 health professionals (including non-nephrologists) had been trained using an electronic health education platform (46). Shortage of nephrology manpower – implication on prevention The resources for nephrology care remain at critical levels in many parts of the world. Even in Western developed countries, nephrologists are frequently in short supply. In a selection of European countries with similar, predominantly public, health care systems, there was a substantial variation in the nephrology workforce. Countries like Italy, Greece, and Spain reported the highest ratios, while countries like Ireland, Turkey, and the UK had the lowest ones (47). In the USA, the number of nephrologists per 1000 ESRD patients has declined over the years, from 18 in 1997 to 14 in 2010 (48). The situation in the developing world is even worse. With the exception of Nigeria, Sudan, Kenya, and South Africa, in many countries of sub-Saharan Africa there are fewer than 10 nephrologists. The number of nephrology nurses and dialysis technicians is also insufficient (49). In Latin America the average number of nephrologists is 13.4 pmp. However, there is unequal distribution between countries; some with o10 nephrologists pmp (Honduras, 2.1 pmp; Guatemala, 3.3 pmp; and Nicaragua, 4.6 pmp), and some exceeding 25 pmp (Cuba, 45.2 pmp; Uruguay, 44.2 pmp; and