Blog: Recap - Tea with Africa session on “Chronic Kidney Disease in Africa: Lived Experiences and Opportunities for Improving Systems of Care"

Tea with Africa: Introduction

The “Tea with Africa” (TWA) series provides an opportunity to engage with and learn from diverse voices and knowledge from Africa. In 2022, we organised three TWA sessions. The first session for the year 2023 coincided with the World Kidney Day. The theme for this year’s World Kidney Day was “Kidney Health for Everyone: Preparing for the Unexpected, Supporting the Vulnerable.” This year’s campaign focused on raising awareness about the impact of kidney disease and the need for equitable access to appropriate diagnostic services, treatment, and care.

Dr. Sradha Kotwal (Head, Renal and Metabolic Division at The George Institute) hosted the event, and the panellists were:

• Dr. Rumbidzai Dahwa - Head of the Renal Department, Sally Mugabe Central Hospital
• Dr. Cindy George - Chair, Chronic Kidney Disease (CKD) Africa Collaboration
• Mr. Lysias Sibanda – A chattered accountant who lives with chronic kidney failure.

Aligning with the theme for this year’s World Kidney Day celebrations, the event was aimed at raising awareness about CKD in Africa, highlighting challenges and opportunities for improving systems of care. The panellists shared insights about living with kidney disease, challenges health workers face in providing care, and proposed solutions.

Dr Kotwal set the stage for the discussion by highlighting the gaps in kidney replacement therapy. She shared from a study led by TGI researchers which estimated that by 2030, more than 5 million people worldwide will need kidney replacement therapy, but only half will be able to access it.  Dr. Kotwal further stated that between 84 and 90% of people in Africa who would need kidney replacement therapy will be unable to access it. The panellists were then invited to share insights on challenges and needs of people living with CKD in Africa, how they have responded to these challenges, and their recommendations for improving systems of care.

Challenges and needs of people living with CKD in Africa

Mr. Sibanda shared his experience living with CKD in Zimbabwe. Since the period leading up to the diagnosis of CKD was symptomless, nothing prepared him for this diagnosis. Not only was he told that he had CKD, but his doctors mentioned that he had reached the end stage of the disease and had waited too long to seek hospital treatment. Mr. Sibanda finally accepted his diagnosis and was ready to begin treatment but complained that he and his family received little support in coping with the financial cost, and the anxiety associated with the process of care. He observed that like him, other people living with CKD in Zimbabwe struggled with the mental health impact of the disease and the financial burden of accessing care.

Dr. Dahwa pointed out that in Zimbabwe, the average age of a person with CKD is 53 years. She remarked that compared to high-income countries, Zimbabwe (and many other African countries) have a young population living with end-stage CKD. Dr. Dahwa commented on the findings from previous studies, which estimated the prevalence of kidney disease in Africa at 13%. In Zimbabwe, about two million people are at risk of developing CKD. As a clinician who witnesses the struggles of people with CKD, she thought these numbers were shocking. She was also concerned that a high prevalence of CKD among a young population in Zimbabwe reduces the country's labour productivity.

Dr. Dahwa highlighted further challenges with accessing CKD treatment in Zimbabwe. Even though a few public health facilities in Zimbabwe started offering free dialysis sessions in July 2018, patients still had to pay for their laboratory tests and medications. There are six kidney specialists in the country, caring for an estimated population of fifteen million.

Dr. George pointed out that while there is insufficient data on the burden of CKD and the genetic risks in Africa, a high prevalence of non-communicable (e.g., Hypertension) and communicable diseases (e.g., HIV) accounts for the rapid progression to kidney failure witnessed among African populations. She also thought that there was a low CKD detection rate and a high demand for kidney replacement therapy in many African countries. Dr. George advised that the demand for kidney replacement therapy could be reduced by screening and providing preventive measures among high-risk groups (including people with pre-diabetes, diabetes, and hypertension).

How panellists have responded to the challenges mentioned above

Mr. Sibanda mentioned that he and others living with CKD in Zimbabwe find ways to cope and rely primarily on their family for support.

Dr George shared about the CKD Africa Collaboration which is an African network of studies on kidney function. The aim of this network is to estimate the burden of CKD in Africa by pooling individual participant-level data from existing African studies. Dr. George also mentioned that the CKD Africa Collaboration is responding to the burden of CKD in Africa by creating resources to guide health services and evidence that might inform policy in a collaborative and coordinated fashion.

Dr. Dahwa mentioned that she noticed a growing awareness among her colleagues who now screen for CKD among high-risk patients. The Kidney Association of Zimbabwe has been organising programs to increase public awareness of CKD. The Association also supports the Zimbabwean health ministry by identifying how it might improve health service planning for people living with CKD. She also noted increased interest in CKD research among post-graduate students in Zimbabwe resulting in various publications. She agreed with Dr. George that there is need to generate relevant evidence to guide policy on CKD care in Africa.

Recommendations from the panellists/Closing remarks

In addition to providing subsidised treatments and access to kidney transplantation, Mr Sibanda highlighted the need to improve public awareness of CKD. He also advised that health ministry's develop programs to support the mental health of patients and their families as they navigate treatment for CKD.

Dr. George invited researchers and institutions to join the CKD-Africa Collaboration in conducting research on CKD. She agreed that more could be done to improve public awareness of CKD and associated risk factors. She recognised that even with effective CKD prevention programs, there will still be need for quality treatment. To improve the current quality of care, she called for better communication between health practitioners, people living with CKD and their families.

Dr. Dahwa agreed with Dr. George and emphasized that improving public awareness is crucial to addressing the rising burden of CKD. She acknowledged that African governments have focused on eradicating infectious diseases, and it was now time to also focus on controlling NCDs, including CKD.

Questions from the audience and responses from the panellists:

Q. How do we drive policy change necessary for CKD prevention and improving access to kidney replacement therapy?

The panellists shared a common observation that African countries can do more to address the systemic issues accounting for the rising burden of CKD and poor access to quality care. They called on people living with CKD and health workers in Africa to increase their advocacy for improved systems of care. They noted the need for collective action  involving people living with CKD, health workers, researchers, health institutions and the government. Since CKD care requires ongoing mental health support, laboratory investigations and treatment of other co-occurring health conditions, they encouraged African governments to subsidise a comprehensive care package for people living with CKD and not focus on dialysis alone.

Q. What about gestational diabetes and CKD? Is there a connection?

In her response, Dr. George stated that gestational diabetes puts women at risk of developing diabetes after delivery, thus increasing CKD risk. She advised that health care workers should screen all pregnant women for gestational diabetes during antenatal care visits, and they should receive appropriate follow-up care after delivery.

Q. Are there sex differences in the prevalence of CKD in Zimbabwe?

Dr. Dahwa noted that unlike the results of studies from high-income countries which showed that 70% of CKD patients on dialysis were male, the reverse was the case for Zimbabwe, with 60% of people on dialysis being female.

Further details on the panellists

Dr. Rumbidzai Dahwa

Dr. Rumbidzai Dahwa graduated with an honour's degree in Bachelor of Medicine and Bachelor of Surgery from the University of Zimbabwe in 2003. She pursued a specialty postgraduate training in Australia with the Royal Australasian College of Physicians and qualified as a Specialist Physician and Nephrologist in December 2013. Dr. Dahwa is also Head of the Renal department at Sally Mugabe Central hospital and a Consultant Physician at Parirenyatwa Hospital. She is a Lecturer in the Internal Medicine Unit at the Faculty of Medicine and Health Sciences, University of Zimbabwe. She is currently pursuing her PhD under the supervision of Prof. Martin Gallagher at The George Institute.

Mr. Lysias Sibanda

Mr. Lysias Sibanda lives with chronic kidney failure and is passionate about improving public awareness of CKD and improving access to better care for CKD in Zimbabwe. He is a member of the Kidney Association of Zimbabwe and leads a non-governmental organization BBRAUN Zimbabwe (Pvt) Limited focused on increasing access to dialysis in Zimbabwe. Additionally, he is a member of the Institute of Chartered Accountants of Zimbabwe with a wide range of experience in the financial sector.

Dr Cindy George

Dr Cindy George is a Senior Scientist at the South African Medical Research Council, a South African National Research Foundation-rated scientist and Africa-Oxford (AfOx) Fellow. She holds a PhD from the University of Stellenbosch, South Africa. Dr. George’s research is centred on chronic kidney disease (CKD) in African populations, focusing on characterizing the burden of CKD and examining the risk factors and underlying mechanisms associated with the disease. She currently manages the CKD-Africa Collaboration. The aim of the network is to pool individual participant data (IPD) to, (1) determine the burden of CKD in Africa, (2) create resources that would allow researchers track the burden of CKD  and (3) enable CKD projections for Africa. To date, the network has access to 60126 IPD from 15 African countries; with more studies in the process of enrolment.

Host: Dr. Sradha Kotwal

Dr. Sradha Kotwal is the Head of The George Institute’s Renal and Metabolic Division-TGI. She is also a clinical nephrologist at the Prince of Wales Hospital in Sydney. She is passionate about increasing clinical trial access for patients with kidney disease. Dr Kotwal has in-depth knowledge of statistical techniques, epidemiology, and clinical trial design (including novel and pragmatic clinical trials). She has worked on projects in India and Fiji looking at the burden of kidney disease and renal replacement therapies.

Further information

• Further information on World Kidney Day https://www.worldkidneyday.org/
   
• Researchers at The George Institute are leading several clinical trials aimed at preventing the progression of kidney disease and its complications. They have also developed expertise in designing and conducting cohort studies that measure the number of people with kidney disease and their outcomes, including the impact on their day-to-day lives. You can find further details about The George Institute’s work on renal and metabolic diseases here.
   
• The George Institute is looking to increase its partnership with researchers and institutions in Africa. Please reach out to Chhavi Bhandari cbhandari@georgeinstitute.org.in and Dr. Kenneth Yakubu kyakubu@georgeinstitute.org.au for any inquiry you may have in this regard.
   
• Chronic Kidney Disease in Africa Collaboration (CKD-Africa) is a network of investigators representing studies related to kidney function and chronic kidney disease from all over Africa. The CKD-Africa Collaboration is an initiative of the Non-Communicable Diseases Research Unit of the South African Medical Research Council. The Collaboration is tasked with compiling and meta-analysing the best available data on kidney measures and clinical outcomes. Further details canbe found on the CKD Africa website Chronic Kidney Disease in Africa Collaboration (samrc.ac.za)