Dialysis or transplant? Tough choices facing kidney patients

Kidney disease is a growing health concern globally and in Kenya, with thousands of patients requiring either dialysis or a kidney transplant. Despite transplants being a more permanent solution, most patients opt for dialysis.

Kidney disease occurs when the kidneys lose their ability to filter waste and excess fluids from the blood. It is classified into two types: acute kidney injury, which is sudden and sometimes reversible, and chronic kidney disease (CKD), a progressive condition that can lead to kidney failure.

Prof. Ahmed Sokwala, a consultant nephrologist at Aga Khan University Hospital, explains, “Kidney disease is a silent disease. Unfortunately, symptoms appear late, often at advanced stages.” These symptoms may include leg swelling, frothy urine, nausea, headaches and difficulty breathing.

Globally, CKD affects approximately 10 per cent of the population, and Kenya follows a similar trend. “Around four to five million Kenyans have some form of kidney disease, but only about 50,000 to 60,000 require dialysis,” Prof. Sokwala estimates.

However, early diagnosis remains a challenge due to a lack of routine screening. The World Health Organisation (WHO) reports that chronic kidney disease is responsible for nearly 1.2 million deaths worldwide each year, highlighting its significant global burden.

The primary causes of kidney failure are diabetes, high blood pressure and glomerulonephritis (kidney inflammation). Other risk factors include overuse of non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac, recurrent infections and genetic predisposition.

Dialysis is a treatment that removes waste, salt and extra water from the blood when the kidneys fail. There are two main types: haemodialysis, where blood is filtered through a machine, and peritoneal dialysis, where a special fluid is introduced into the abdominal cavity to absorb waste. Prof. Sokwala describes dialysis as a ‘stopgap measure’ that allows patients to survive while awaiting a transplant. A kidney transplant, on the other hand, involves replacing the failed kidney with a healthy one from a living or deceased donor. “Transplantation provides better survival rates and quality of life than dialysis,” Prof. Sokwala notes. However, it requires lifelong immunosuppressive medication to prevent rejection. Importantly, donors do not require medication before or after donation. “A donor only needs to be healthy with a matching blood group, and they can live a normal life with just one kidney,” Prof. Sokwala explains.

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Despite the advantages of transplants, many Kenyan patients prefer dialysis. According to the Kenya Renal Association, the number of dialysis patients in Kenya has increased exponentially in recent years, reflecting the rising incidence of CKD. “Approximately 50,000 to 60,000 people in Kenya are currently on dialysis, making up about 1 per cent of those with kidney disease,” says Prof. Sokwala.

Significant challenges

One of the main reasons for this trend is limited access to transplants. Kenya only permits living-related kidney donations, unlike many countries that also allow deceased donor transplants, significantly reducing the pool of available kidneys. Cultural and religious beliefs also play a role, with some Kenyans holding superstitions about organ donation, fearing it affects the afterlife. “Organ donation involves extensive counselling to dispel myths,” Prof. Sokwala explains.

Cost barriers further deter many patients. While the National Health Insurance Fund (NHIF), now the Social Health Authority (SHA), covers dialysis costs, kidney transplants and post-operative care remain expensive for many families. Additionally, a lack of awareness about the benefits of transplants leads some patients to perceive dialysis as a more manageable option.

Misconceptions about kidney disease and transplants persist, preventing patients from making informed choices. One common myth is that drinkcoconut water can heal the kidneys. “Coconut water is high in potassium, which can be harmful to kidney patients,” warns Prof. Sokwala.

Another widespread belief is that kidney disease cannot be inherited. “In reality, some kidney conditions, like polycystic kidney disease, run in families,” he adds. Additionally, many fear they cannot live with one kidney, but “some people are even born with only one kidney and lead normal lives,” says Prof. Sokwala.

While hydration is essential for kidney health, another common misconception is that drinking more water will help kidney disease. Prof. Sokwala clarifies, “If your kidneys are weak, they struggle to eliminate excess water, leading to fluid buildup, swelling and breathing difficulties.” Thus, water intake should be carefully monitored in patients with advanced kidney disease.

Preventing kidney disease involves lifestyle changes, including maintaining a healthy diet, exercising and avoiding excessive salt, sugar and over-the-counter painkillers. Prof. Sokwala advises, “If you are over 40, get screened for diabetes, blood pressure and kidney function to detect problems early.”

For Kenya to increase transplant uptake, policy changes are needed, including the introduction of a deceased donor programme. Prof. Sokwala highlights the urgent need to improve donor availability.