Kenya’s dialysis boom: Why are kidney transplants still so rare?

Prof Ahmed Sokwala, an associate professor at Aga Khan University Medical College, explains

by JOHN MUCHANGI

Health17 March 2025 - 23:16

In Summary

The number of transplants in the country is quite low. From 2012 to 2022, only 708 kidney transplants were done in Kenya, versus 5,700 patients who were on hemodialysis.

Kidney disease in Kenya is on the rise with approximately four million Kenyans (one in every 10 people) having some form of kidney disease, according to statistics from the Kenya Renal Association (KRA).

Specifically, the estimated number of patients with End Stage Kidney Disease (ESKD) who require kidney transplants is 12,500.

By October 2022, about 6,300 of these patients were undergoing chronic hemodialysis treatments. Many of the rest did not qualify for dialysis after the defunct NHIF tightened the eligibility criteria.

The number of transplants in the country is quite low. From 2012 to 2022, only

708 kidney transplants were done in Kenya, according to KRA. In 2021, there were only 160 kidney transplants versus 5,700 patients who were on hemodialysis. This is a transplant conversion rate of 2.8 per cent, against a rate of approximately 10 per cent that has been observed globally.

Why is this the case? Kidney transplant is considered better than dialysis because it offers a significantly higher quality of life, longer life expectancy, and eliminates the need for regular dialysis sessions, which can be time-consuming and restrictive.

Prof Ahmed Sokwala, an associate professor, Aga Khan University Medical College, and consultant nephrologist at Aga Khan University Hospital in Nairobi, explains.

What is causing this increased numbers of chronic kidney disease and kidney failure?

Diabetes and high blood pressure is the number one cause of kidney disease; and because more patients have diabetes and high blood pressure, we're seeing more kidney disease. However, other risk factors can include heart disease, smoking and obesity. Aging is also a risk factor. Studies have shown that after the age of 40, kidney function begins to fall by approximately one percent each year. This is coupled by the fact that our diets are very westernized and highly salted, lack of physical exercise not to mention our polluted environment.

What is acute kidney disease and how different is it from chronic kidney disease?

Kidney disease can either be acute or chronic, acute kidney disease occurs in very sick patients. This causes a sudden loss of kidney function. In most cases, patients usually get well within a few days but urgent treatment, including dialysis, is needed as they await full recovery.

Chronic kidney disease (CKD), on the other hand, refers to the progressive loss of kidney function over a long period. Those at the highest risk of CKD are people with hypertension, diabetes, obesity and a family history of the disease.

How does kidney transplant expertise locally compare with the West?

For many decades’ patients with chronic kidney disease and kidney failure requiring kidney transplantation were sent overseas. However, we now have the technology, expertise and we have the capability of performing the transplants in the country. Having a kidney transplant in locally comes with a number of benefits including reduced cost because there is not travel and accommodation required just the cost of treatment. Patients are also saved from the hassle of applying for passports and visas that will enable them to travel for treatment, which adds on to their stress. Follow-up is an important component of kidney transplant and many patients who undergo transplant outside the country have had difficulties with follow-up care to minimize the chances of rejection. With local transplants, you are able to connect with your doctors with ease without traveling hustles and this improved follow-up care.

However, we still have many kidney patients traveling outside the country for kidney transplants only to realise later that having it locally would have been a better option overall.

We still have so many patients on dialysis despite transplant being the best treatment, why is this the case?

There are many patients on dialysis and fewer receiving transplants primarily because of a shortage of available donor organs, and some patients may not be healthy enough for a transplant, while others may prefer dialysis. Some patients, especially older adults, may prefer the continued dialysis over the risks and complications of a transplant, which may require lifelong immunosuppressant drugs to prevent organ rejection.

What does the law stipulate when it comes to organ donation in Kenya?

In Kenya, the law only allows one source of kidneys for transplantation. This means that kidney donation is legally permissible only from living related donors, which means blood relatives of the recipient up to the fourth degree of consanguinity. The restriction to related families has equally contributed to reduced kidney transplant cases given that sometimes non-related healthy people can be compatible to donate kidneys.

Generally, donors should be between the ages of 18 and 65 years and the recipient and donor must have either the same blood group, or compatible groups.

What lifestyle adjustments can we adopt to prevent suffering chronic kidney disease?

To prevent kidney disease, the World Health Organisation recommends an active lifestyle, controlling blood sugar levels, monitoring blood pressure, healthy eating, avoiding regular use of over the counter drugs and smoking.