Efforts to tackle the rising burden of CKD in Africa reveal the unmasked silent pandemic

Chronic kidney disease (CKD) is a global public health concern affecting approximately 850 million individuals worldwide. The gradual deterioration of kidney function can lead to kidney failure or end-stage kidney disease, requiring dialysis or transplantation. CKD has witnessed a significant increase in mortality rates, making it the 10th leading cause of global deaths. Conditions such as acute kidney injury and Alport syndrome contribute to the progression of CKD and its associated complications. The disease affects the vital functions of the kidneys, impacting waste removal, fluid balance, and hormone regulation.

Undiagnosed cases of CKD are prevalent, and the disease is closely linked to cardiac and cardiovascular events. Nephron loss, often irreversible, is associated with metabolic and cardiovascular disorders. In the African continent, efforts are being made to improve kidney care, adopt technology in treatments, implement policy recommendations, and emphasize preventive measures to alleviate the burden of CKD. Healthcare Middle East & Africa provides valuable insights into the current state of kidney care and strategies to combat this silent disease.

Soaring undiagnosed cases of CKD in Africa

Chronic kidney disease (CKD) is becoming a significant public health concern in Africa, with a rising number of undiagnosed cases. Several factors contribute to this alarming trend, including financial barriers, limited access to treatment, inadequate awareness of kidney diseases, and delays in diagnosis by healthcare professionals. These challenges hinder patients with CKD from seeking appropriate healthcare, leading to further disease progression. Understanding the prevalence of CKD is essential for developing effective strategies to address this issue.

Financial barriers pose a significant challenge to accessing healthcare services for individuals with CKD in Africa. Many patients face financial constraints that prevent them from seeking medical attention until the disease has advanced. Additionally, the scarcity of kidney care facilities and a shortage of nephrologists further impede timely access to treatment and optimal care delivery. Limited awareness among the general population and healthcare professionals about kidney diseases also contributes to delayed diagnoses. Addressing these challenges requires a comprehensive approach that involves early detection and effective management of the condition.

Recent studies provide valuable insights into the prevalence and distribution of CKD in Africa. The Global Burden of Disease (GBD) study indicates a pooled prevalence of CKD in general and high-risk populations in Africa ranging from 10.1% to 15.8%. Regional variations are observed, with North Africa reporting the lowest prevalence at 4%, followed by East Africa at 11.0%, Southern Africa at 12.2%, Central Africa at 16%, and West Africa at 16.5%. These statistics underscore the significant burden of CKD in Africa and the urgent need for targeted interventions and comprehensive healthcare strategies.

Efforts to detect and manage CKD in specific countries highlight the severity of the problem. In Kenya, for example, more than 1.8 million people are affected by kidney diseases, with nearly 500,000 individuals living with chronic kidney disease and over 6,000 patients receiving dialysis treatments as of March 2023. Similarly, South Africa estimates that around 5 million individuals aged 20 years and above may be affected by CKD, greatly impacting their quality of life. The COVID-19 pandemic has further exposed the challenges faced by patients with renal disease in countries like Liberia, where access to essential assistance became even more difficult during the crisis.

Egypt is also experiencing a significant increase in the burden of CKD, with the disease ranking as the fifth leading cause of death. The majority of patients undergoing dialysis in Egypt are men, primarily aged 55 years and above. Hypertension is the most common cause of end-stage kidney disease (ESKD), followed by diabetes and glomerulonephritis. Addressing the underlying causes of CKD and implementing prevention and management strategies are crucial in Egypt.

The concentration of hemodialysis centers in major cities poses a barrier to adequate treatment, forcing patients from rural areas to travel long distances. Efforts should be made to decentralize dialysis services and establish satellite centers in rural areas to improve patient access to care. Moreover, inadequate resources and operational challenges in government-supported facilities contribute to the strain on hospitals and hinder effective management of CKD and its complications. Increased investment in healthcare infrastructure, including the procurement of dialysis machines and healthcare professional training, is vital to meet the growing demand for renal care.

In Nigeria, kidney failure claims the lives of nearly 45,000 individuals each year, with close to 50,000 patients requiring kidney transplants or dialysis annually. Accessible and affordable treatment options, including improved dialysis services and increased availability of organs for transplantation, are urgently needed in the country.

Thousands missing out on early intervention regimes

Early diagnosis of CKD plays a crucial role in slowing the loss of kidney function and reducing the risk of kidney failure. However, thousands of individuals around the world are missing out on the opportunity for early intervention, according to recent data. The World Health Organization has cautioned that at least 251.4 million people globally required preventive treatment for CKD in 2021. This highlights the urgent need for effective implementation of CKD screening and national action plans for prevention and early diagnosis, particularly in Africa.

Preventive services have the potential to save lives and improve health outcomes by detecting early-stage disease, designing effective disease management interventions, and allowing for earlier treatment before complications arise. The National Library of Medicine emphasizes that screening for CKD should be a policy priority in low- to middle-income countries, as early intervention can significantly reduce the burden of morbidity and mortality associated with CKD.

In the advanced stages of CKD, key kidney functions, such as waste removal, blood pH control, and electrolyte and hormone production, are greatly compromised. This leads to an accumulation of nitrogenous wastes, increased blood acidity, and potassium overload, which significantly increase morbidity and mortality risks. Individuals with long-term diabetes face an even higher risk of irreversible kidney damage, as diabetic nephropathy, also known as diabetic kidney disease (DKD), is a serious complication that can arise in those with type 1 or type 2 diabetes.

The high incidence of CKD in Africa is further exacerbated by low detection rates and the combined prevalence of heart diseases, heart attacks, heart failure, and strokes. When kidneys lose approximately 90 percent of their filtering and waste-removal ability, kidney failure occurs, impeding the production of urine. Initially, the loss of renal tissues does not exhibit symptoms of kidney disease because the remaining tissues compensate by becoming more actively involved in kidney functions. However, without early medical interventions, this renal adaptation eventually leads to renal insufficiency and progression to renal failure.   

To address this issue, hospitals have started offering comprehensive chronic kidney disease screening packages, including blood pressure checks, urine tests, creatinine tests, and consultations with nephrologists. Renal function testing involves analyzing serum creatinine and urea levels, serum electrolyte levels, urinary sediment, urine output, and urinalysis. In advanced stages, ultrasound tests are performed to detect renal obstructions and differentiate between chronic kidney disease and acute kidney injury.

As novel screening alternatives for CKD emerge, many dialysis centers are well-equipped to provide services to patients with electrolyte disorders, acute kidney diseases, renal stones, glomerular diseases, lupus nephritis, diabetic nephropathy, and proteinuria. Point-of-care testing for kidney disease offers the opportunity for more timely treatment changes and preventing the progression of the illness.

In Kenya, eligible citizens can access a comprehensive benefits package covering hemodialysis, routine laboratory tests, medications, nursing services, specialist reviews, follow-up care, and counseling through the National Insurance Fund. However, the prevalence of chronic kidney disease remains high in low- and middle-income communities, posing a significant development challenge. The annual cost of hemodialysis in Kenya, Senegal, and Nigeria alone is US$1.7 billion, US$3.5 billion, and US$450 million, respectively, accounting for a substantial portion of the countries’ total domestic government health costs.

Unlocking innovations in Diabetic Kidney Disease treatment

According to the Multidisciplinary Digital Publishing Institute, diabetic kidney disease affects approximately 40% of people with type 2 diabetes, with an estimated 160 million individuals worldwide suffering from both diabetes and CKD. In Africa alone, diabetes mellitus affects 9.4 million people. Alarmingly, the International Diabetes Federation projects that Africa is expected to witness the highest relative increase in diabetes cases, with a projected 156% rise between 2017 and 2045. Type 2 diabetes (T2D) is a chronic condition that leads to elevated blood sugar levels and carries the potential risk of damaging the eyes, kidneys, and heart.

Current treatment approaches for diabetic kidney disease focus on controlling blood pressure and blood sugar levels, reducing dietary protein intake, avoiding medications that may harm the kidneys, treating urinary tract infections, and implementing exercise and weight loss regimens. Anemia, characterized by low hemoglobin levels, is also a common complication of CKD and can be observed early in the disease’s development.

However, there is a glimmer of hope on the horizon. Experts have made significant strides in discovering ways to delay kidney damage caused by CKD, even for individuals currently taking medications for diabetes, anemia, or high blood pressure. Innovative products and solutions have emerged, offering potential risk reduction for end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization due to heart failure.

One such breakthrough is Astellas Pharma’s orally-administered drug, Roxadustat, also known as Evrenzo. Extensive research has demonstrated its safety and cost-effectiveness, making it a potential game changer in addressing the unmet medical needs of patients with anemia of CKD, particularly in Egypt. Similarly, Bayer introduced Finerenone, marketed as Kerendia, as a treatment for chronic kidney damage associated with type 2 diabetes. These drug discoveries offer promising solutions for managing CKD and its complications.

Novo Nordisk, a leading pharmaceutical company, is also making remarkable strides in the field. They are set to launch a once-a-week insulin regime, currently undergoing clinical trials across 27 sites involving 217 patients in India. This development follows Novo Nordisk India’s successful introduction of oral semaglutide, the world’s first and only “peptide in a pill,” which has revolutionized diabetes management.

These novel drugs have demonstrated efficacy in improving the estimated glomerular filtration rate (eGFR), a key marker of kidney function. Regulatory approvals for these treatments are based on robust evidence of their ability to prevent kidney function loss, slow disease progression, and ultimately enhance the lives of patients living with chronic illnesses.

In the realm of FDA-approved medications, GSK’s Jesduvroq has emerged as an oral, once-a-day treatment for adults with anemia due to CKD who have been on dialysis for at least four months. Initially approved under the brand name Duvroq in Japan in June 2020, the drug has also made significant progress in its marketing authorization application (MAA) with the European Medicines Agency (EMA) accepting it for review in March 2022. Following successful clinical trials, the US FDA granted approval for the drug under the brand name Jesduvroq in February 2023.

Looking ahead, major pharmaceutical companies are focusing on developing treatment solutions that offer multi-organ protection to patients. This integrated approach aims to address the complex interplay between various organ systems affected by CKD, ultimately leading to better outcomes for patients.

A steady path of progress in advancing nephrology in Africa

Nephrology, the branch of medicine focused on kidney health, has experienced slow but significant progress in Africa. Efforts are being made by governments and healthcare entities to address the growing demand for specialized care and improve outcomes for patients with chronic kidney disease (CKD). Key initiatives include the establishment of public health infrastructure, provision of medical equipment to dialysis centers, and training programs for healthcare professionals in nephrology.

The Global Kidney Health Atlas 2019 reveals that kidney transplantation is available in several African countries, including North Africa, South Africa, Namibia, Kenya, Tanzania, Ethiopia, Mauritius, Seychelles, Nigeria, Ghana, and Cote D’Ivoire. These transplantation programs offer hope and improved treatment options for patients in need.

Notably, Kenya is making significant strides in kidney disease management. The construction of the East Africa Kidney Institute (EAKI) is currently underway, promising to introduce cost-effective approaches to kidney disease management in the region. EAKI will act as a hub for organ and tissue donations, overseeing dialysis, renal replacement, and transplantation. Kenya has also established its first-ever tissues and transplant authority to ensure the ethical and safe use of human cells, tissues, and organs within the country.

Moreover, Kenya has taken significant steps to enhance kidney disease management and organ transplantation. Kenyatta National Hospital has established the Histocompatibility and Immunogenetics Laboratory, the first of its kind in East Africa, which facilitates organ matching for transplantation. Additionally, the hospital has established the Centre for Kidney Disease & Organ Transplantation under the ‘Interlife’ program, positioning itself as a regional center of excellence in kidney care.

The Africa Healthcare Network (AHN) has played a pivotal role in advancing renal health in Sub-Saharan Africa. As the largest dialysis chain in the region, AHN offers high-quality dialysis services at an affordable cost. AHN’s dialysis centers in Rwanda, Tanzania, Kenya, and Ghana have contributed to the development of a comprehensive registry for chronic kidney disease patients in East Africa. Furthermore, AHN has implemented educational awareness campaigns and improved patient access to quality dialysis treatments.

In West Africa, Liberia celebrated a significant milestone with the inauguration of its first national dialysis center, the EJS Dialysis Center, in 2022. This center has alleviated the financial and logistical burdens faced by Liberians who previously had to travel abroad for dialysis services. Mauritius has also made notable progress in renal care by establishing a Hemodialysis Unit at the New Souillac Hospital, with plans for a Renal Transplant Unit and additional Hemodialysis Unit at the Jawaharlal Nehru Hospital in Rose Belle.

Government officials across Africa are actively engaging in partnerships with multinational pharmaceutical companies, as well as national and regional nephrology societies, to ensure patient access to affordable and high-quality medications and therapies. Collaborative efforts with organizations such as the South African Renal Society, the Egyptian Society of Nephrology and Transplantation, and the African Association of Nephrology reflect a commitment to enhancing patient care and expanding treatment options.

Although progress in nephrology in Africa has been gradual, the collective efforts of governments, healthcare institutions, and partnerships with international organizations and societies are paving the way for improved kidney disease management. As these initiatives continue to unfold, Africa’s nephrology landscape holds promise for better outcomes and enhanced quality of life for individuals affected by CKD.

Advancing treatment approaches in CKD

To improve outcomes for patients with chronic kidney disease (CKD), there are ongoing multinational randomized clinical trials aimed at evaluating the effectiveness of specific drugs in slowing down CKD progression and reducing the risk of cardiovascular mortality. These trials seek to develop innovative treatment approaches that can effectively address CKD and decrease the chances of kidney failure in vulnerable patients.

One notable study is the DISCOVER CKD trial, sponsored by AstraZeneca. It is an international observational cohort study that includes both prospective and retrospective patient cohorts. The objective of this study is to assess early treatment experiences, treatment patterns, treatment effectiveness, patient outcomes, and quality of life by comprehensively collecting prospective and retrospective data from CKD patients.

Another significant trial, called EMPA-KIDNEY and led by Boehringer Ingelheim and Eli Lilly and Company, is a multinational randomized, double-blind, placebo-controlled clinical trial. It specifically focuses on evaluating the impact of empagliflozin on the progression of kidney disease and the risk of cardiovascular mortality.

Although progress in nephrology in Africa has been gradual, the collective efforts of governments, healthcare institutions, and partnerships with international organisations and societies are paving the way for improved kidney disease management


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This trial stands out as the first to involve an SGLT2 inhibitor in CKD research, demonstrating significant kidney and cardiovascular benefits for adults with CKD.

In South Africa, efforts are underway to explore the potential of medicinal plants in the treatment of CKD. Researchers are studying ten plant species from nine botanical families that are commonly used in traditional medicine for CKD and other kidney-related diseases. These initiatives highlight the importance of introducing innovative medications, promoting health screening, and improving the standard of care for CKD patients throughout African countries.

These ongoing clinical trials and developments in medication underscore the urgent need for coordinated action to introduce innovative treatments, advocate for health screening, and enhance the standard of care for individuals living with CKD in African nations. By fostering collaboration between pharmaceutical companies, research institutions, and healthcare providers, there is hope for improved management and outcomes for CKD patients across the continent.

Global pharmaceutical companies are making significant investments in research and development (R&D) to advance the development of high-quality medicines and therapies for chronic kidney disease (CKD). According to a recent study by GlobalData, leading companies in the CKD pipeline drugs market include AstraZeneca Plc, Bayer AG, Novo Nordisk AS, Algernon Pharmaceuticals Inc., and Angion Biomedica Corp.

The integration of artificial intelligence (AI) is revolutionizing the field of nephrology and improving the lives of individuals affected by chronic kidney disease. Robot-assisted nephrectomy surgeries, powered by AI, offer several benefits. These advanced procedures allow doctors to perform surgeries with greater precision and efficiency, resulting in shorter hospital stays and faster recovery times for patients. The use of robotic-assisted surgery also leads to reduced post-operative pain and eliminates the need for special wound hygiene measures due to smaller incisions. For example, Burjeel Medical City in Mohamed Bin Zayed City has recently introduced kidney transplantations using the latest 3D laparoscopic technology, a minimally invasive method that has transformed the field of nephrology.

In addition to surgical advancements, experts are exploring emerging technologies to treat chronic kidney diseases. One approach involves using the patient’s own cells to restore organ function, leveraging regenerative medicine techniques. Furthermore, medical device companies are focusing on bringing AI-based tools and genomic precision medicine tests to emerging markets. These innovations promote early detection of CKD and provide personalized treatment options based on an individual’s genetic profile.

Advancements in kidney disease initiatives and transplantation efforts

Campaigns and initiatives worldwide play a vital role in raising awareness about kidney disease and promoting positive health-seeking behaviors. At the same time, partnerships between government entities and strategic partners emphasize the significance of organ and tissue donation and transplantation. Additionally, advancements in peritoneal dialysis therapy and post-transplant care are improving treatment options and outcomes for patients.

Starting with kidney disease awareness campaigns, the Iya Project Kidney Disease Awareness Campaign (2011) encourages positive health-seeking behaviors among individuals at risk of chronic kidney disease. Similarly, the Nephropathy Early Detection initiative, part of the 100 Million Healthy Lives campaign, focuses on identifying chronic nephropathy in vulnerable groups in Egypt. Under a national campaign, the Ministry of Health and Population in Egypt has screened approximately 6.5 million citizens for kidney disease since September 2021.

When individuals reach end-stage kidney disease, they require kidney replacement treatments such as regular dialysis or kidney transplantation. Kidney transplantation is the primary treatment option for those with renal failure. The global prevalence of CKD is estimated to be approximately 15.1%, with an estimated 4.9 to 7.1 million patients requiring renal replacement therapy due to end-stage kidney disease.

Advancements in transplantation efforts are also noteworthy. The United Arab Emirates’ National Program for Donation and Transplantation of Human Organs and Tissue, known as “Hayat,” highlights the importance of organ and tissue donation. Moreover, King Faisal Hospital in Rwanda is equipped with advanced technology and multidisciplinary teams, expanding access to transplantation services by offering kidney transplants.

To promote kidney donation and transplantation, governments are encouraging community members to register as kidney donors. Rwanda aims to provide both living-related and deceased donor transplant options for end-stage renal disease patients. Multidisciplinary transplant teams conduct complex surgical procedures, providing comprehensive care and instilling hope in patients and their families.

Peritoneal dialysis (PD) therapy offers a favorable option for at-home dialysis, reducing infection risks and enabling independent management with proper training. As predicted by GlobalData, there is a growing demand for home care solutions, including wearable and portable dialysis systems, which offer advantages over in-clinic hemodialysis treatment.

Post-transplant care and support are crucial for the well-being of recovering dialysis patients. Support groups in end-to-end renal facilities bring patients together, fostering motivation and minimizing challenges related to physical mobility, self-care, and daily activities. Emerging technologies enable doctors to monitor key blood biomarkers, ensuring that post-renal transplant patients maintain excellent renal function and overall well-being.

Policy and equity in kidney care are gaining prominence. Policymakers worldwide are working to transform national laws on organ donation and transplantation, aiming to improve access to nephrology care for all without financial hardships. The recognition of kidney transplantation as a significant milestone in kidney care underscores the importance of equitable access to treatment and support.

The prospects for managing chronic kidney disease in Africa

The global burden of chronic kidney disease looms large, projected to become the fifth leading cause of premature death by 2040. With millions succumbing to this disease annually and countless lives disrupted by dialysis, urgent action is needed. However, the risk of death from kidney surgery is low, and living with one kidney does not affect life expectancy. A multidisciplinary approach to managing related conditions can alleviate this burden on individuals and society, particularly in terms of catastrophic health expenditures.

In Africa, addressing the diverse needs of kidney patients is crucial as countries strive to achieve Sustainable Development Goal targets. The Africa Renal Registry, established in 2015, provides valuable data for developing effective strategies. Governments must allocate funds to establish specialized centers, reduce waiting lists, and equip dialysis centers with advanced treatments and technology. Offering transplantation options and attracting medical tourists will further enhance kidney care services.

Stricter laws against organ trafficking are necessary, facilitating the establishment of transplant services. Community education and state-supported screening programs raise awareness, promote healthy lifestyles, and combat kidney disease. Early detection through community-based initiatives can delay the need for dialysis. However, the scarcity of nephrologists in Africa necessitates urgent training and retraining of healthcare workers in the field.

This feature appeared in the June 2023 issue of Healthcare Middle East & Africa. You can read this and the entire magazine HERE