Your kidneys work quietly, filtering waste, balancing fluids and regulating blood pressure every single day. Most people never think about these essential organs until something goes wrong and, unfortunately, statistics show that kidney disease is a growing problem. Millions of South Africans are affected by kidney disease and many do not even know they have it. 

The good news is that kidney disease is one of the most preventable and manageable chronic conditions when detected early.

Experts from the North-West University (NWU) and the Klerksdorp/Tshepong Hospital Complex say there is encouraging news for kidney health. The tools needed to detect, manage and slow kidney disease are already widely available. The main challenge is making sure that people know their risks and get tested before symptoms develop.

Three experts from these institutions agree that kidney disease deserves far more attention than it is currently getting because it is both common and, in many cases, preventable. These experts are Prof. Petra Bester, director of the NWU’s Africa Unit for Transdisciplinary Health Research (AUTHeR) and operations lead for the Desmond Tutu School of Medicine; Prof. Binu Luke, consultant physician in internal medicine and chief director and head of the Desmond Tutu School of Medicine; and Dr Wanis Shali, consultant nephrologist and head of the clinical unit at the Klerksdorp/Tshepong Hospital Complex.

A growing but manageable challenge

Chronic kidney disease (CKD) affects a significant portion of South Africa's adult population. According to Prof. Bester, national estimates suggest between 6% and 17% of adults are living with the condition, while a rural study in Mpumalanga found a prevalence of 6,7%.

This means that many South Africans who are living with reduced kidney function are unaware of it. This is particularly concerning because kidney disease is closely linked to conditions such as hypertension, diabetes and HIV, which already affect large numbers of South Africans.

The experts point out that according to the South African Annual Renal Report 2024, hypertension-related kidney disease is the leading cause of kidney failure, accounting for 42,4% of cases. Diabetes is another major contributor, while HIV infection, even when well controlled on treatment, nearly doubles the risk of developing kidney disease.

They stress that managing these chronic conditions and protecting kidney health go hand in hand.

What happens when kidneys fail?

Early kidney disease may be silent, but advanced kidney failure is not. Once kidneys stop functioning adequately, patients require dialysis or a kidney transplant to survive.

Data from the South African Renal Registry show that 9 093 people were receiving dialysis or living with a functioning kidney transplant at the end of 2024. This compares with 8 881 dialysis cases in the previous year. 

During 2024 alone, 1 091 people started treatment for kidney failure.

The figures also highlight stark inequalities in access to care. While the national prevalence of dialysis and transplant treatment stood at 144 people per million population, the rate was 754 per million in the private sector compared with only 41 per million in the public sector.

This disparity underscores the importance of prevention and early diagnosis. Once kidneys fail completely, treatment options become far more limited, particularly for patients who depend on the public healthcare system.

Time to take control by understanding your risk

There are a host of major risk factors for kidney disease. These include high blood pressure, diabetes or pre-diabetes, HIV infection, a family history of kidney disease, obesity and physical inactivity, smoking and the long-term use of certain over-the-counter pain medications.

The experts say having one or more of these risk factors is not necessarily cause for alarm. It is, however, a strong reason to get screened.

Because kidney disease often develops without symptoms, waiting until you feel ill may mean missing an opportunity to detect problems early.

Screening for kidney disease does not require complex procedures. There are two simple tests that are available at most clinics and many pharmacies. These are:

•    A urine test that checks for protein, which can be an early sign of kidney damage.
•    A blood test measuring creatinine levels, which helps estimate how effectively the kidneys are filtering waste.

People living with hypertension, diabetes or HIV are encouraged to ask their healthcare provider to include these tests during routine check-ups.

Do not ignore these signs

Symptoms often appear only when kidney disease has already progressed.

Warning signs which tend to appear in more advanced stages include:

• Swelling of the ankles, feet or around the eyes

• Persistent tiredness

• Difficulty concentrating

• Foamy or bubbly urine

• Increased urination, particularly at night

• Loss of appetite

• Unexplained nausea

• Muscle cramps, especially during the night

“While these symptoms do not automatically mean someone has kidney disease, they should be discussed with a healthcare professional,” says Prof. Bester.

Why prevention matters

The experts note that dialysis and transplantation are life-saving treatments but also resource-intensive interventions. 

In the North West Province, specialised nephrology services are available through facilities such as the Klerksdorp/Tshepong Hospital Complex and Job Shimankana Tabane Hospital, while additional dialysis services are provided at Mafikeng Provincial Hospital and Joe Morolong Memorial Hospital.

However, the most effective public health strategy remains preventing kidney disease from progressing to advanced stages. Controlling blood pressure and diabetes, the two leading causes of chronic kidney disease, can significantly reduce the risk of serious kidney complications.

As the experts emphasise, looking after your kidneys begins with understanding your health numbers and taking action early.

"Kidney disease is common, but it is also one of the more preventable and manageable chronic conditions we know of. Knowing your blood pressure, blood sugar and kidney function may be one of the simplest investments you can make in your future health,” they conclude.

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