Chronic Kidney Disease in South Africa: A Growing Public Health Crisis

Chronic kidney disease (CKD) has become a significant health concern in South Africa, driven by a combination of factors including HIV, tuberculosis, hypertension, diabetes, and obesity. The disease disproportionately affects Black African populations due to genetic predispositions and socio-economic disparities. Despite the growing burden of CKD, South Africa's public healthcare system struggles to provide adequate care, with limited dialysis slots, transplant opportunities, and workforce shortages.

Key Takeaways:

• The intersection of HIV, tuberculosis, hypertension, diabetes, and obesity has created a significant burden of chronic kidney disease in South Africa.
• Black African populations are disproportionately affected due to high-risk apolipoprotein L1 (APOL1) variants, which compound risk factors.
• Public-sector dialysis slots have remained static since 1994, while the private sector has expanded rapidly, exacerbating inequities by province and income.
• Transplant access is limited by organ shortages, logistical barriers, and variable provincial resources.
• Children and adolescents face additional barriers, including limited age-specific pathways and the absence of structured transition to adult care.
• Workforce shortages, inadequate regulatory oversight, inconsistent procurement processes, and incomplete registry reporting undermine service quality and limit access to equitable care.
• Scaling equitable dialysis and transplantation services, integrating kidney paired donation (KPD) programs, and investing in prevention, workforce, and infrastructure are critical to reversing current trends.

Statistics:

• CKD is a growing public health crisis in South Africa, driven by the intersecting burdens of HIV, tuberculosis, hypertension, diabetes, and obesity.
• Public-sector dialysis slots have remained static since 1994, while the private sector has expanded rapidly.
• Only 10% of patients with end-stage renal disease (ESRD) have access to kidney transplantation.
• Children and adolescents face limited age-specific pathways and the absence of structured transition to adult care, resulting in delayed or discontinued care.
• An estimated 20% of South Africa's population is at risk of developing CKD due to hypertension, diabetes, and obesity.

Sources:

• A roadmap for kidney health for South Africa in the context of universal health coverage. South African Medical Journal, 2025,115(9).
• Obesity & Diabetes Week. October 20, 2025; p 74.
• South African Medical Association (Publisher).