Rising Dialysis Patients in South Africa Linked to Unhealthy Lifestyles, Hypertension, and Diabetes

Johannesburg – South Africa is witnessing a notable rise in cases of kidney failure, with over 9,300 individuals currently undergoing dialysis or receiving kidney transplants.

As we approach National Kidney Awareness Week (1–5 September), there is heightened concern regarding the growing number of South Africans requiring dialysis and transplants, indicative of the escalating prevalence of lifestyle-related diseases.

Worrying Increase in Kidney Replacement Therapy

The most recent national dataset from the South African Renal Registry (2022 Annual Report released last year) shows that by December 2022, at least 9,342 patients nationwide were on chronic dialysis or had received kidney transplants, up from 8,866 in 2021.

This trend underscores a persistent increase, revealing a significant public health challenge.

The report indicates an overall prevalence of 151 per million population (pmp), with a stark disparity in service availability between the private and public sectors.

The private healthcare sector noted a prevalence of 771 (pmp), while the public sector recorded only 45 pmp.

Within the public sector, the Western Cape exhibited the highest provincial prevalence (165 pmp), whereas Mpumalanga had the lowest (3 pmp).

Access to dialysis in the public sector is often restricted due to resource limitations, with strict eligibility criteria varying by province and facility.

Admission decisions are generally made by a multidisciplinary committee, focusing primarily on transplant suitability and overall clinical benefit.

Factors such as medical fitness, severe uncontrolled comorbidities, treatment adherence, and availability of social support are carefully considered.

Active substance use is typically regarded as a disqualifying criterion.

As a result, numerous patients who do not meet these criteria are compelled to seek treatment in the private sector, provided they have the financial means.

These challenges highlight an urgent need to tackle the underlying causes of kidney failure.

Lifestyle, Hypertension, and Diabetes Contribute to Kidney Disease

As stated by the National Kidney Foundation of South Africa (NKFSA), kidney failure in adult South Africans is mainly associated with hereditary hypertension (60–65%) and type 2 diabetes (20-25%).

Ingrid Singels, Head of the Scientific Division at Pharma Dynamics, emphasizes that both hypertension and type 2 diabetes are conditions that can be prevented, detected early, and effectively managed.

This proactive methodology could prevent 70–80% of all chronic kidney failures and/or cardiovascular deaths.

Furthermore, she highlights that kidney disease is often asymptomatic.

“Many individuals with hypertension or diabetes may not show symptoms until significant kidney damage has occurred, making early screening and preventative measures crucial,” stated Singels.

“Prioritize Prevention Over Cure”

As National Kidney Awareness Week approaches, Singels stresses the importance of focusing on preventative measures.

“We cannot afford to wait until patients progress to kidney failure,’’ she remarked.

“By improving hypertension and diabetes management through education, screening, and early intervention, we can greatly alleviate the burden on individuals and the healthcare system.”

This aligns closely with the NKFSA’s message that numerous cases of chronic kidney disease and cardiovascular deaths can be avoided with timely interventions.

She also points out significant demographic trends.

“A 15-year analysis on chronic kidney disease by Discovery Health indicates that among their medical scheme members, the average age for those on chronic dialysis was 57 years, while transplant recipients had an average age of 47 years.

“This suggests that many individuals in the working-age population are affected by advanced kidney disease, raising serious concerns regarding the social and economic implications for families and workplaces.”

In addition to human costs, Singels notes that dialysis is extremely expensive, particularly in the private sector, where annual expenses can surpass hundreds of thousands of rands per patient.

“Every avoided case of kidney failure not only saves a life but also frees up essential healthcare resources for other pressing needs,” Singels adds.

“That’s why it’s vital to empower South Africans with practical tools to improve diet, physical activity, and disease management before kidney damage arises.”

Call to Action

With over 9,300 South Africans currently undergoing kidney replacement therapy, and most cases associated with preventable conditions, immediate action is essential:

• Understand Your Health Metrics: Regularly monitor your blood pressure and blood sugar levels, especially if you have risk factors like a family history or obesity.
• Embrace Heart-Healthy Practices: Following a balanced diet low in salt, sugar, and saturated fats alongside regular exercise can help mitigate the progression of hypertension and diabetes.
• Get Screened Early: Since kidney disease can be asymptomatic, early detection through screening can significantly influence patient outcomes.
• Seek Care Before It’s Too Late: If detected early, lifestyle modifications and medical interventions can postpone the onset of kidney failure.

The dual challenges of rising dialysis numbers and preventable causes should inspire broader initiatives.

“By shifting the emphasis from treating end-stage disease to prevention, South Africa has a true opportunity to reverse the trajectory of kidney failure—saving lives and alleviating strains on the healthcare system,” Singels concludes.