Hypertension and diabetes top causes of kidney disease

As the world marked World Kidney Day yesterday, kidney disease is on the rise both in Kenya and globally, with approximately four million Kenyans (1 in every 10 people) having some form of kidney disease, according to statistics from the Kenya Renal Association. Even with these high numbers, a big percentage of patients are on dialysis and transplants account for a very small percentage when it comes to treatment.

We recently had a chat with Prof Ahmed Sokwala, Associate Professor, Aga Khan University Medical College and Consultant Nephrologist at Aga Khan University Hospital Nairobi to try understand this trend.

People Daily: First, could you tell us what is causing the increase in kidney disease cases?

Prof Ahmed Sokwala: Diabetes and high blood pressure are the leading causes of kidney disease. The rising prevalence of these conditions has contributed to the increasing number of kidney disease cases. However, other risk factors, such as heart disease, smoking and obesity, also play a role. Aging is another significant factor; studies have shown that after the age of 40, kidney function tends to decline by approximately one per cent each year. This is further compounded by our westernised diets, which are often high in salt, lack of physical exercise and environmental pollution.

PD: Take us through the different types of kidney disease and how they affect kidney function?

PAS: Kidney disease can either be acute or chronic. Acute kidney disease occurs in very sick patients. This causes a sudden loss of kidney function. In most cases, patients usually get well within a few days but urgent treatment, including dialysis, is needed as they await full recovery. Chronic kidney disease (CKD), on the other hand, refers to the progressive loss of kidney function over a long period. Those at the highest risk of CKD are people with hypertension, diabetes, obesity and a family history of the disease.

PD: How has kidney disease treatment evolved in Kenya over the years?

PAS: For many decades, patients with chronic kidney disease and kidney failure requiring transplantation were sent overseas for treatment. However, with advancements in technology and expertise, we now have the capability to perform kidney transplants within the country. Having a kidney transplant locally offers numerous benefits, including reduced costs since there is no need for travel or accommodation expenses, just the treatment costs.

Patients are also spared the stress of applying for passports and visas for overseas travel. Follow-up care is a crucial aspect of kidney transplants, and many patients who undergo transplants abroad have struggled with post-operative care to prevent rejection. With local transplants, patients can easily connect with their doctors, ensuring improved follow-up care.

Despite these advantages, many kidney patients still travel abroad for transplants, only to later realise that having the procedure locally would have been a better option overall.

PD: Kidney transplants is the best treatment for kidney failure but we still have so many patients on dialysis. Why is this the case?

PAS: This is primarily due to shortage of available donor organs. Kidney transplant programmes are heavily reliant on organ donation, and the number of people who voluntarily donate their kidneys often falls short of the demand. The process of organ donation itself is complicated by factors such as organ matching, where compatibility between donor and recipient must be carefully assessed to minimise the risk of rejection.

Additionally, some patients may not be healthy enough for a transplant, while others choose dialysis over surgery. For certain patients, particularly older adults, the risks and complications associated with a transplant, such as the need for lifelong immunosuppressant drugs to prevent organ rejection, may make dialysis a preferred option.

PD: What does the law stipulate when it comes to organ donation in Kenya?

PAS: In Kenya, the law only allows one source of kidneys for transplantation. This means that kidney donation is legally permissible only from living related donors, which means blood relatives of the recipient up to the fourth degree of consanguinity. The restriction to related families has equally contributed to reduced kidney transplant cases given that sometimes non-related healthy people can be compatible to donate kidneys. Generally, donors should be between the ages of 18 and 65 years and the recipient and donor must have either the same blood group, or compatible groups.

PD: What lifestyle changes can Kenyans make to help prevent kidney disease?

PAS: To prevent kidney disease, the World Health Organisation recommends an active lifestyle, managing blood sugar levels, monitoring blood pressure, eating a healthy diet, and avoiding the regular use of over-the-counter medications and smoking. Additionally, staying hydrated and maintaining a healthy weight can further support kidney health. Regular physical activity helps improve overall circulation and reduces the risk of conditions like diabetes and hypertension, which are major contributors to kidney disease. By making these lifestyle adjustments, Kenyans can significantly reduce their risk of developing kidney disease and improve their overall well-being.

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