Chronic Kidney Disease (CKD) is rapidly becoming a critical concern in Africa, posing significant challenges for public health and healthcare systems. Shedding light on this escalating issue, a recent position paper authored by 13 senior leaders from the African Association of Nephrology, delves into the growing prevalence of CKD in the region. In commemorating World Kidney Day on 14 March 2024, this paper underscores the urgent need for attention and action to address CKD in the region.  

The research paper's authors (titled “Transporting Sodium-Glucose Cotransporter-2 Inhibitors to the African Continent: Challenges and Solutions”) call for concerted efforts to implement effective strategies to mitigate the escalating incidence of CKD across the continent.  

CKD is a progressive condition characterised by a loss of kidney function, with serious consequences for health and well-being. It stands as the 10^th leading cause of death globally, affecting over 850 million people worldwide. Most of these cases are concentrated in low- and middle-income countries with Africa bearing a significant portion of the burden.  

The position paper sheds light on the alarming increase in CKD prevalence in Africa, fuelled by a triple burden of health challenges. The prevalence of CKD ranges from 6% to 20% across different regions, indicating a significant burden on healthcare systems. Notably, the rising rates of non-communicable diseases such as diabetes and hypertension, coupled with persistent infections like HIV and hepatitis B and C, are worsening the situation. With approximately 24 million adults reported to have diabetes in Africa, this figure is projected to rise to 33 million by 2030 and 55 million by 2045.  

Barriers and Challenges  

The hurdles faced by Africa in tackling CKD are intensified by socioeconomic disparities, which not only limit access to essential healthcare resources but also magnify the repercussions of CKD across the continent. Among the notable challenges are limited financial resources, low health literacy, and inadequate medical reimbursements. Furthermore, the absence of CKD registries and real-world data adds another layer of complexity to address the issue. The report emphasizes the importance of developing educational materials, gathering regional data, and enhancing healthcare accessibility as crucial steps in overcoming these barriers.  

A concerning revelation emphasized in the position paper is the diagnosis of CKD at a younger age in Africa, compared to individuals experiencing kidney failure in higher-income regions. It’s startling that many individuals with CKD in sub-Saharan Africa (SSA) are initially diagnosed with kidney failure, highlighting the severe impact of resource constraints, insufficient access to primary care services, and inadequate screening. Sadly, interventions at this advanced stage often prove futile for many patients, particularly in SSA. 

According to Professor Abdou Niang, MD, FWACP, Head of the Nephrology Department at Cheikh A. Diop University in Dakar and President-elect of the African Association of Nephrology, “CKD is a silent killer that we must know how to detect early, in order to provide an effective response to avoid going to the dialysis stage, the cost of which is inaccessible to most populations on the African continent.” 

Managing and Treating CKD  

Central to the paper’s recommendation is recognising sodium-glucose cotransporter-2 inhibitors’ (SGLT2i) clear benefits in managing CKD.  These innovative medications offer promise in reducing the complications associated with CKD, providing new avenues for improving outcomes. The authors highlight the importance of integrating SGLT2 inhibitors into standard care protocols to maximise their impact and address the evolving needs of CKD patients across Africa.  

Furthermore, the position paper stresses the critical importance of early detection and timely intervention in CKD to prevent kidney failure and save lives. Recognising the challenges current diagnostic methods pose, the authors propose practical alternatives such as dipstick detection for proteinuria. This cost-effective approach to screening offers a viable solution to overcome barriers to diagnosis and improve access to care for underserved populations. 

Dr Hussein Bagha, Consultant Physician and Nephrologist at MP Shah Hospital in Nairobi, Kenya, further emphasised that CKD progression can be delayed significantly if diagnosed early. “The use of SGLT2 inhibitors together with RAAS blockers can significantly delay the progression of CKD to End-Stage Kidney Disease(ESKD) requiring renal replacement therapy by up to 25 years if diagnosed early.”

In alignment with the theme of World Kidney Day, the paper advocates for a paradigm shift in how CKD is approached and managed in Africa. It calls for a comprehensive and feasible clinical approach to screening, diagnosis, and treatment, emphasising the need for equitable access to care and optimal medication practices. The authors stress the importance of political will, capacity building of healthcare workers and patients, affordable pricing, and availability of medications to achieve kidney health for all in Africa and beyond.  

As the continent grapples with the growing burden of CKD, the time is now for concerted action to scale up quality kidney care in Africa. With collaboration, innovation, and a commitment to equitable healthcare, significant strides can be made toward improving outcomes and ensuring a healthier future for all. 

Dr Khomotso Mashilane, Medical Director at AstraZeneca: “AstraZeneca is committed to supporting initiatives that address the prevalence of chronic kidney disease in Africa. We commend the authors of this position paper for their comprehensive and sober representation of the challenges faced in managing CKD on the continent. Their emphasis on the potential value of SGLT2 alongside standard care is a crucial step in reducing the burden and morbidities associated with CKD in Africa.”