As South Africa marks National Kidney Awareness Week from 1–5 September, new data has cast a worrying spotlight on the nation’s kidney health. The number of people requiring dialysis and transplants is climbing steadily – a reflection of the rising tide of lifestyle-related diseases.
The South African Renal Registry’s most recent report shows that by December 2022, a staggering 9 342 patients nationwide were receiving chronic dialysis or had undergone a kidney transplant. That’s up from 8 866 in 2021 – a clear indication of a worsening public health challenge.
Access to dialysis in the public sector is a major challenge, guided by strict eligibility criteria that differ by province. Multidisciplinary committees decide who qualifies, largely based on transplant suitability, overall clinical benefit, and the ability to adhere to treatment.
Patients with severe, uncontrolled comorbidities or active substance use are often excluded. Those who don’t qualify must rely on the private sector – provided they can afford the steep costs.
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The silent roots of kidney failure
The National Kidney Foundation of South Africa (NKFSA) highlights that the overwhelming majority of kidney failure cases stem from preventable causes: inherited hypertension (60–65%) and type 2 diabetes (20–25%).
According to Ingrid Singels, head of the scientific division at Pharma Dynamics, this is both a warning and an opportunity. She explains,
“Both hypertension and type 2 diabetes can be prevented, diagnosed early and properly treated. In doing so, 70–80% of all chronic kidney failure and/or cardiovascular deaths are potentially preventable.”
The challenge, she adds, is that kidney disease often creeps up unnoticed.
“Many individuals with high blood pressure or diabetes may show no symptoms until kidney damage reaches an advanced stage, making early screening and preventive interventions all the more critical.”
Ingrid Singel
This year’s Kidney Awareness Week carries a strong message: the fight must focus on prevention.
“We cannot afford to wait for patients to develop kidney failure,” says Singels. “By supporting better management of hypertension and diabetes, through education, screening and early intervention, we can dramatically reduce the burden on individuals and the healthcare system.”
The NKFSA echoes this stance, pointing out that timely action could spare thousands of families the hardship of chronic kidney disease and cardiovascular death.
A disease of working-age adults
Kidney failure doesn’t only affect the elderly. A 15-year analysis from Discovery Health shows that among medical scheme members, patients on chronic dialysis had an average age of 57, while transplant recipients averaged 47.
“This suggests that many individuals in the working-age group are affected by advanced kidney disease, raising concerns about social and economic impact on families and workplaces,” notes Singels.
Beyond the human cost, dialysis is enormously expensive. In the private sector, annual treatment can run into hundreds of thousands of rands per patient.
“Every case of kidney failure prevented represents not only a life saved, but also scarce healthcare resources freed up for other pressing needs,” Singels adds.
Protect your kidneys
With more than 9 300 South Africans now dependent on kidney replacement therapy, the message is clear: prevention is key. Experts urge the public to take practical steps to protect kidney health:
- Know your numbers: Regularly monitor blood pressure and blood sugar, particularly if you have a family history or are overweight.
- Adopt heart-healthy habits: Eat a balanced diet low in salt, sugar and saturated fat, and aim for regular physical activity.
- Screen early: Because kidney disease can be silent, routine testing can catch problems before they become irreversible.
- Seek care early: If detected in time, lifestyle changes and medical treatment can slow or even halt progression to kidney failure.
The rising demand for dialysis is not inevitable. By shifting focus from treating end-stage disease to preventing it, South Africa has an opportunity to change course.
As Singels puts it: “By shifting focus from treating end-stage disease to preventing it, South Africa has a real opportunity to turn the tide on kidney failure – saving lives and relieving pressure on the health system.”
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