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

Johannesburg – South Africa is witnessing a marked rise in kidney failure cases, with over 9,300 people currently on dialysis or awaiting kidney transplants.

As National Kidney Awareness Week (1–5 September) draws near, concerns are mounting about the growing number of South Africans requiring dialysis and transplantation, highlighting the escalating burden of lifestyle-related illnesses.

Worrying Increase in Kidney Replacement Therapy

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

This trend underscores a significant public health issue.

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

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

Within the public sector, the Western Cape had the highest prevalence (165 pmp), while Mpumalanga recorded the lowest (3 pmp).

Due to limited resources, access to dialysis in the public sector is often rationed and comes with strict eligibility criteria, which vary by province and treatment facility.

Admission decisions are usually made by a multidisciplinary committee based on transplant suitability and overall clinical benefits.

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

Active substance use is typically a disqualifying factor.

This has led many patients who do not meet these stringent criteria to seek treatment in the private sector, assuming they can afford it.

Such challenges highlight the urgent need to address the root causes of kidney failure.

Unhealthy Lifestyles, Hypertension, and Diabetes Contribute to Kidney Disease

As reported by the National Kidney Foundation of South Africa (NKFSA), kidney failure among adult South Africans is primarily attributed to hereditary hypertension (60–65%) and type 2 diabetes (20-25%).

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

A proactive approach could potentially prevent 70–80% of chronic kidney failure and/or cardiovascular-related deaths.

Moreover, she highlights that kidney disease often progresses without noticeable symptoms.

“Many individuals with hypertension or diabetes might not show symptoms until the condition has significantly deteriorated, underscoring the importance of early screening and preventive actions,” noted Singels.

“Shift Towards Prevention Rather Than Cure”

As National Kidney Awareness Week approaches, Singels emphasizes the necessity for a greater focus on preventive measures.

“We cannot afford to wait until patients reach the stage of kidney failure,” asserted Singels.

“Improving the management of hypertension and diabetes through education, screening, and early intervention can substantially reduce the burden on individuals and the healthcare system.”

This perspective aligns with the NKFSA’s message that many cases of chronic kidney disease and cardiovascular deaths are preventable with timely interventions.

She also draws attention to significant demographic trends.

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

“This indicates that many individuals of working age are affected by advanced kidney disease, raising serious concerns about the social and economic impact on families and workplaces.”

In addition to human costs, Singels points out that dialysis is extremely expensive, particularly in the private sector, where costs can exceed hundreds of thousands of rands annually per patient.

“Every case of prevented kidney failure not only saves lives but also reallocates critical healthcare resources to other pressing needs,” notes Singels.

“That’s why empowering South Africans with practical tools to enhance diet, exercise, and disease management before kidney damage occurs is crucial.”

Call to Action

With over 9,300 South Africans currently undergoing kidney replacement therapy, the majority of cases linked to preventable conditions underscore the urgent need for public action:

• Know Your Health Numbers: Regularly monitor blood pressure and blood sugar levels, especially if you have risk factors like a family history or obesity.
• Adopt Heart-Healthy Practices: Maintaining a balanced diet low in salt, sugar, and saturated fats, along with regular exercise, can help manage hypertension and diabetes.
• Early Screening is Key: Since kidney disease can often remain undetected, early screening can significantly improve outcomes.
• Seek Care Before It’s Too Late: Early identification allows for lifestyle changes and medical interventions that can delay kidney failure onset.

The increasing rates of dialysis combined with preventable causes should catalyze broader initiatives.

“By focusing on prevention rather than treating end-stage disease, South Africa has a genuine opportunity to reverse the kidney failure trend—saving lives and reducing pressures on the healthcare system,” concludes Singels.