GlobeMed at Brown University

Chronic Kidney Disease in the developing world

Annabel Lemma

Chronic Kidney disease (CKD), also referred to as chronic renal disease, is a progressive loss of kidney function over a period of time.  The natural course of CKD extends from being susceptible to the disease, exposed to the risk factors and to development of CKD that progresses to End Stage Renal Disease (ESRD). The fast progression of the illness together with the very high medical costs associated with it makes Chronic Kidney Disease one of the most dangerous diseases worldwide. Chronic kidney is now the cause of hundreds of thousands of deaths every year.¹ It is highly pronounced today because of the rapid increase in its prevalence, the enormous cost of treatment, and most importantly, because of its major role in heightening the risk of cardiovascular disease and other complications. Especially in developing nations where the health care system is not very advanced, these effects can be highly aggravated.

It has been suggested that as many as 100 million individuals may be affected by chronic kidney disease globally.⁴ Provision of care for patients who require dialysis or transplantation is a major and growing healthcare problem in both developed and emerging nations in terms of cost, premature mortality and economic impact. It is estimated that over 2 million patients with ESRD worldwide are currently on renal replacement therapy (RRT), at a global cost of around one trillion dollars.¹ 90% of all treated ESRD patients reside in the West, as the prohibitive cost precludes renal replacement therapy in most developing nations. Though there is not an official registry for renal disease cases in most developing countries,¹ it is undeniable that its effect is more pronounced in the part of the world where health care is at its worst.

Chronic kidney disease is at least 3-4 times more frequent in Africa than in developed countries. Hypertension affects approximately 25% of the adult population and is the cause of chronic kidney failure in 21% of patients on renal replacement therapy in the South African Registry. The prevalence of diabetic nephropathy is estimated to be 14%-16% in South Africa, 23.8% in Zambia, 12.4% in Egypt, 9% in Sudan, and 6.1% in Ethiopia.⁵ The current dialysis treatment rate ranges from 70 per million population in South Africa to < 20 pmp in the most of sub-Saharan Africa. The transplant rate in Africa averages 4 pmp. ⁵

The unavailability of medical supplies, physicians, technology are all contributory factors to this reality. There is so much that could be done to decrease the severity of the problem starting from creating awareness in the community about the disease and how it can possible be prevented, campaigns for early treatments are also another options.