?World Kidney Day is celebrated annually on the second Thursday of March (13 March in 2025). In an opinion piece for the Daily Maverick, Prof Yazied Chothia from the Division of Nephrology writes that even though new treatments have emerged that may further slow the progression of chronic kidney disease, many of these treatments are unavailable or too expensive for public healthcare in South Africa.
- Read the original article below or click here for the piece as published.
?Yazied Chothia*
Chronic kidney disease (CKD) is becoming a major global health concern, affecting about 1 in 10 adults. In many low- and middle-income countries, including South Africa, the number of CKD cases is rising due to conditions like high blood pressure and diabetes, combined with infections, pregnancy-related complications, and exposure to harmful substances. While the exact number of people with CKD in South Africa is unclear, estimates suggest it could be as high as 17%.
Despite the growing number of patients, access to treatment remains extremely limited, especially for those whose kidneys fail and need dialysis or a transplant. South Africa's public healthcare system, which serves most of the population, struggles with severe resource constraints, leading to strict rationing of life-saving treatments. Meanwhile, private healthcare offers much better access, but only a small percentage of South Africans can afford it.
?Because many people will not have access to dialysis or transplants, preventing CKD from worsening is critical. Medications that protect kidney function, such as renin-angiotensin-system inhibitors, have played an essential role in treatment. In recent years, new therapies have emerged that may further slow the progression of CKD. It is important that we pay closer attention to these new drugs, especially on World Kidney Day, which is celebrated annually on the second Thursday of March (13 March in 2025). The theme for this year is 'Are Your Kidneys OK? Detect early, protect kidney health'.
New drugs
A new class of medications called sodium-glucose cotransporter inhibitors or SGLT2 inhibitors is showing great promise in protecting kidney function for people with or without diabetes and CKD. These drugs help reduce stress on the kidneys by lowering pressure inside them, decreasing harmful glucose buildup, and improving overall metabolism. Large clinical trials have shown that SGLT2 inhibitors slow kidney disease progression and reduce hospitalisations and deaths related to kidney and heart disease.
Diabetes is a growing problem in South Africa, affecting approximately 11% of the population. It is also a major cause of kidney disease. According to the latest South African Renal Registry report, nearly 13% of people receiving kidney replacement therapy were diabetic. While SGLT2 inhibitors could help slow CKD progression, their use in the country is unequal. Patients in private healthcare have access to these drugs, but they remain out of reach for most people in the public healthcare system due to cost barriers. Experts believe these medications could play a crucial role in preventing kidney failure in Africa, especially given the limited availability of dialysis and transplants.
Another diabetes medication, such as glucagon-like peptide 1 receptor agonists or GLP-1 RA, also known as semaglutide, has recently been shown to not only slow down progression of CKD in those who have diabetes but also reduce death caused by both kidney failure, strokes and heart attacks. In addition, this drug has also been shown to cause significant weight loss when used together with lifestyle changes in people who are overweight or obese. However, as with SGLT2 inhibitors, this drug is only available to those who have access to private healthcare.
HIV and kidney disease
With 12.7% of South Africans living with HIV, the virus is a major cause of kidney disease in the country. HIV-associated nephropathy (HIVAN), which damages the kidneys' ability to filter waste in people with HIV, is one of the most common forms of kidney disease linked to the virus. A genetic factor called the APOL-1 gene is associated with an increased risk of developing HIVAN. Scientists have been studying new treatments targeting this gene, and a recent trial of a drug called inaxaplin showed promising results, reducing kidney damage by nearly 50% in 13 weeks. While these new therapies offer hope, antiretroviral treatment remains the most important way to protect kidney health in people living with HIV. Future research could help make these new treatments more widely available, particularly in sub-Saharan Africa, where APOL-1-related kidney disease is most common.
Blood types and animal-to-human transplants
In the past, people with incompatible blood types (ABO-incompatible, or ABOi) could not receive kidney transplants. However, advances in medical devises now allow transplants between different blood groups using special treatments to prevent rejection. Doctors at Groote Schuur Hospital in Cape Town recently performed three successful ABOi kidney transplants using a new medical device. While the early results are promising, more research is needed to confirm long-term success before this becomes a routine care.
Another emerging field is xenotransplantation, which involves transplanting organs from animals to humans. In March 2024, doctors in the United States transplanted a genetically modified pig kidney into a human for the first time. Sadly, the patient passed away two months later, though the cause of death was not related to kidney rejection. With long waiting lists for kidney transplants and high mortality rates among those waiting, xenotransplantation could be a lifesaving option in the future. However, it is still an experimental procedure, and more research is needed to ensure its safety and effectiveness. Additionally, ethical, cultural, and religious concerns may impact how widely it is accepted.
After years of limited progress, exciting new treatments for CKD have emerged, many of which have been developed through diabetes research or advances in understanding kidney disease at a molecular level. However, most of these treatments are unavailable or too expensive for public healthcare in South Africa, where most CKD patients seek care. Access to these therapies is restricted mainly by high costs and reliance on imported medicines.
Solutions could include prioritising CKD in health policies, expanding universal healthcare coverage, and boosting local pharmaceutical production. Even existing, affordable treatments are sometimes underused due to gaps in medical knowledge and overburdened healthcare workers. Addressing these issues through education and better working conditions is essential. As more South Africans develop CKD, system-wide efforts are needed to ensure life-saving treatments reach those who need them most.
?*Yazied Chothia is an associate professor and medical specialist in the Division of Nephrology in the Department of Medicine at Stellenbosch 肆客足球.
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