Promotion of kidney care in countries with limited resources: How does the National Kidney Foundation of South Africa fare?

Abstract

An often-quoted remark is to present problems as challenges, which invariably end up in the "in-box", eventually to be swept under the carpet. The chronic kidney disease burden in the South African black population poses a challenging crisis requiring immediate intervention even in a country with limited resources. Aims, materials, and methods: The National Kidney Foundation of South Africa (NKFSA) reports on 3 major projects. The schools project is aimed at prevention, early diagnosis, and appropriate management of chronic kidney disease (CKD) on a national basis. The second "urgency" is to educate primary healthcare workers (including doctors) about relevant kidney diseases and their treatment. The third illustrates the suboptimal number of dialysis facilities and the dismal number of kidney transplants performed in the public sector compared to treatment in the private sector. This accentuates the unacceptable two-tiered system in South Africa (SA). The NKFSA school survey showed that in black adolescent learners, hypertension was found in 12% of females and 16% of males (often associated with familial hypertension). An increase in body mass index (BMI) showed better correlation in hypertensive females than in males (p<0.004). Of 4 obese females, 3 had newly diagnosed type II diabetes. Urine dipsticks showed 1 student with hematuria, 1 with overt proteinuria, and many with active urinary tract infections. The educational book will appear as continuing medical education (CME) articles in two issues of the South African Medical Journal. The prevalence of patients obtaining treatment for end-stage renal disease (ESRD) (2012) was 73 pmp in the public and 620 pmp in the private sector. Depending on the region, the mean number of live-related transplants pmp/year varied between 0.6 and 5.3 (average 2.2) in the public and 10 to 33 (average 20.4) in the private sector. Deceased donor (DD) transplants varied between 0.75 and 7.0 (average 3.5) pmp/year in the public and 5.2 to 24.0 (average 17.1) in the private sector. The schools project has demonstrated that early prevalence of hypertension in the black population validates the need for an extensive, nationwide study, which should result in prevention and early diagnosis of hypertension thus reducing progression to renal failure. We hope to enhance the education, of both public and medical personnel, on the major problems of CKD in SA through the CME articles. The huge disparity in the treatment of ESRD between the public and private sectors as well as a marked variation in regional treatment needs urgent attention. Because living donor transplants in the black population remains very limited, novel methods of obtaining more DD organs must be formulated.