Kidney disease is a growing health crisis in Kenya, yet despite significant advancements in dialysis services, kidney transplants remain rare. Statistics from the Kenya Renal Association (KRA) reveal that approximately four million Kenyans about one in every ten people are living with some form of kidney disease. Of these, around 12,500 have reached End Stage Kidney Disease (ESKD), a condition requiring either dialysis or a kidney transplant to survive. However, only about 6,300 patients were on chronic hemodialysis by October 2022, a figure partially limited by recent restrictions on the now-defunct National Hospital Insurance Fund (NHIF), which tightened the eligibility criteria for dialysis funding.
Despite this dialysis boom, transplant numbers remain alarmingly low. Between 2012 and 2022, only 708 kidney transplants were performed in Kenya, while over 5,700 patients remained dependent on dialysis. In 2021 alone, there were just 160 transplants, amounting to a transplant conversion rate of 2.8 percent, starkly contrasting the global average of approximately 10 percent. This discrepancy persists even though kidney transplants generally offer better outcomes compared to dialysis. Transplant recipients often enjoy longer life expectancy, improved quality of life, and are free from the time-consuming routine of dialysis sessions.
Prof Ahmed Sokwala, associate professor at Aga Khan University Medical College and consultant nephrologist at Aga Khan University Hospital in Nairobi, attributes the rising burden of kidney disease to lifestyle-related factors. He notes that the increase in diabetes and hypertension, both primary causes of kidney disease, is a key driver of the epidemic. Additionally, other contributors such as heart disease, smoking, obesity, and aging especially as kidney function tends to decline by about one percent each year after age 40 compound the problem. He also highlights the influence of Westernized diets, high salt intake, sedentary lifestyles, and environmental pollution as exacerbating factors.
Prof Sokwala explains that kidney disease can be acute or chronic. Acute kidney injury often arises suddenly in severely ill patients, but many recover with prompt treatment, including temporary dialysis. Chronic kidney disease (CKD), however, develops over time and progressively worsens, particularly among those with diabetes, hypertension, obesity, or a genetic predisposition.
Historically, Kenyan patients needing kidney transplants had to travel abroad for the procedure, but that is no longer necessary. Local healthcare facilities now boast the technology and expertise to conduct successful transplants. Opting for a local transplant can significantly reduce costs by eliminating travel and accommodation expenses, and patients benefit from easier follow-up care, essential for minimizing transplant rejection. Yet, despite these advantages, many patients still seek transplants abroad, often realizing too late that local treatment would have been more convenient and affordable.
The low transplant numbers are not only due to patient preference or health conditions but are also influenced by legal constraints. In Kenya, kidney donations are legally restricted to living, related donors blood relatives up to the fourth degree. This limitation means many potential transplants from non-related but compatible donors cannot proceed, reducing the donor pool significantly. Furthermore, donors must be between 18 and 65 years old, and must have compatible blood types with recipients, narrowing eligibility further.
Prevention remains a key strategy in addressing the kidney disease crisis. The World Health Organization advises maintaining an active lifestyle, managing blood sugar and blood pressure, eating healthily, avoiding unnecessary use of over-the-counter medications, and quitting smoking. These measures, if widely adopted, could help curb the rise in chronic kidney disease and reduce the growing dependency on dialysis.
Ultimately, while Kenya has made great strides in dialysis availability, bridging the gap in kidney transplant rates will require legal reforms, public awareness, and greater investment in transplant infrastructure to ensure that patients can access the best possible care.
