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

Johannesburg – South Africa is witnessing a troubling rise in kidney failure cases, with more than 9,300 individuals currently on dialysis or awaiting kidney transplants.

As we approach National Kidney Awareness Week (1–5 September), concern is mounting over the escalating number of South Africans requiring dialysis and transplantation, revealing the increasing impact of lifestyle-related illnesses.

Worrying Increase in Kidney Replacement Therapy

The most recent national data from the South African Renal Registry (2022 Annual Report released last year) shows that by December 2022, at least 9,342 patients in the country were receiving chronic dialysis or had undergone kidney transplants, an increase from 8,866 in 2021.

This trend underscores a persistent public health challenge.

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

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

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

Access to dialysis in the public sector is constrained by resource limitations, leading to rationing and strict eligibility criteria that vary by province and treatment facility.

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

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

Active substance use generally serves as a disqualifying criterion.

As a result, many patients who do not satisfy these criteria are compelled to seek treatment in the private sector, provided they can afford it.

These challenges highlight the critical need to address the root causes of kidney failure.

Unhealthy Lifestyles, Hypertension, and Diabetes Contribute to Kidney Disease

The National Kidney Foundation of South Africa (NKFSA) states that kidney failure in adult South Africans is mainly attributed to inherited 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 can be prevented, diagnosed early, and managed effectively.

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

She further points out that kidney disease often develops silently.

“Many individuals suffering from hypertension or diabetes may show no symptoms until significant kidney damage has occurred, making early screening and preventive measures crucial,” remarked Singels.

“Shift Focus from Treatment to Prevention”

In light of National Kidney Awareness Week, Singels stresses the importance of preventive measures.

“We cannot afford to wait for patients to reach the point of kidney failure,’’ she stated.

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

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

She also highlights significant demographic trends.

“A 15-year analysis on chronic kidney disease by Discovery Health reveals that among their medical scheme members, the average age for patients on chronic dialysis was 57 years, while those receiving transplants averaged 47 years.

“This indicates that individuals in the working-age population are increasingly affected by advanced kidney disease, raising significant concerns about the social and economic impacts on families and workplaces.”

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

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

“That’s why it’s essential to empower South Africans with practical tools to improve their diet, exercise, and disease management before kidney damage occurs.”

Call to Action

With over 9,300 South Africans currently undergoing kidney replacement therapy and the majority of cases linked to preventable conditions, immediate action is required from the public:

• 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 Habits: A balanced diet low in salt, sugar, and saturated fats coupled with regular exercise can help slow the progression of hypertension and diabetes.
• Get Screened Early: Since kidney disease can be asymptomatic, early detection through screening can greatly influence outcomes.
• Access Care Before It’s Too Late: If detected early, lifestyle changes and medical treatments can postpone the onset of kidney failure.

The dual realities of increasing dialysis numbers and preventable causes should inspire broader initiatives.

“By shifting our focus from treating end-stage disease to preventing it, South Africa genuinely has the opportunity to reverse the trend of kidney failure—saving lives and reducing strain on the healthcare system,” concludes Singels.