An interview with Dr. Gachanja David KamauChronic kidney disease (CKD) is a rising burden globally and is considered a hidden epidemic on the African continent that is just now beginning to gain attention. Although there is not much data locally looking at the prevalence of CKD, we are seeing a higher rate in populations in Sub-Saharan Africa compared to global statistics. From the few studies done so far, it seems to show that the prevalence in Africa is about 14%, which is significantly higher than the global average of about 10%.
The management of chronic kidney disease in Africa is challenging because of the limited numbers of specialists that we have, as well as the slow speed of identification and diagnosis of the disease. We see many late diagnoses, which means that, by the time patients reach a specialist or even enter a hospital, they are often in advanced stages of the disease. We also have less screening and identification of CKD at the primary care level.
For therapeutic options, including medication, the standard treatment is out of reach for many due to cost and/or proximity to the appropriate health facility or expert. And, of course, there is an element of health inequity in general with limited access to renal replacement therapy (RRT). Given that it's a chronic disease, there is associated high treatment cost including hospitalisation, dialysis, and so on. This is a significant economic burden and most patients who really need this kind of chronic disease care management can't afford it.
Most causes of CKD are usually nonspecific. Chronic kidney disease is a progressive loss in kidney function over a period of months or years. The kidneys are damaged and can’t filter blood the way they should. Diabetes is a leading risk factor for kidney disease followed by hypertension. Interestingly, patients with CKD are likely to also have CV disease, amplifying the disease burden and, therefore, the goal in kidney disease management should be aimed at reducing the progression to kidney failure and to prevent complications.
Other causes of kidney disease include structural damage in conditions like glomerulonephritis, which is a group of diseases that cause inflammation and damage the kidney's filtering units. There are also some genetic factors as well. In West Africa, there is a gene variant (APOL1 risk alleles) for that population that confers a greater risk of developing chronic kidney disease.
Most of the time, the symptoms are very nonspecific and not so clear cut. This is part of the reason why patients present so late because the symptoms could point to several different disorders or illnesses, like loss of appetite, nausea, swelling of the feet and ankle, dry, itchy skin, and/or muscle twitching. While each is very nonspecific, these are quite common signs and symptoms of kidney disease.
Firstly, we don't have sufficient resources in terms of renal units or renal specialists in Africa. Most patients get diagnosed late because of weak health systems, inadequate primary health care, poor identification of early acute kidney injury/disease (AKI) as well as inadequate capacity for renal transplantation. It is therefore a key important element that primary care health should focus on early identification of kidney disease in at risk populations and enhance capacity for timely referrals.
Urine and blood tests are some of the simple diagnostic/screening methods that can be done at primary care level. Therefore, empowering healthcare practitioners through disease awareness campaigns and education can contribute to better outcomes along the kidney disease patient journey reducing progression to end stage disease (kidney failure).
Governments and many institutions have been advocating for building capacity for healthcare practitioners, ensuring that they are well trained, so there has been an increased focus on capacity building across different cadres (e.g., for renal nurses). I've seen some devolved counties in Kenya creating renal units and the Government of Kenya is also building a higher-level institution, a regional centre of excellence in urology and nephrology in partnership with the International Society of Nephrology aimed at building more capacity and training for renal specialists.
The medical community has been at the forefront in advocating for better kidney care in the society. I've also seen targeted campaigns about screening for the disease, such as World Kidney Day, World Diabetes Day or World Heart Day. Kidney health is impacted positively when other non-communicable diseases (NCDs) are addressed, as both diabetes and heart failure are key risk factors for CKD.
Since we have an existing burden, most of our patients are quite advanced in the disease, so in the intermediate, Africa would benefit from expanded access to renal replacement therapy or dialysis coverage by national health insurances. And, of course, if you look at Africa in general, there's a whole consortium of academia (from West Africa, North Africa, South Africa) that are bringing together renal experts to come up with registries to better understand the burden of disease, prevalence and do some research into the populations that are more higher at risk.
At Boehringer Ingelheim, we are driven by the ambition to serve humankind by improving human and animal health with a sole purpose of transforming lives for generations! Through this call for application by the Making More Health Accelerator program, I am positive that social enterprises working on the healthcare sector to address the unmet needs especially in kidney care will benefit beyond the funding to the co-creation efforts geared towards sustainable healthcare business around kidney care. We want to bring attention to the challenge of chronic kidney disease, bringing it to the forefront of healthcare conversations so that it is no longer a hidden epidemic.
We also hope to find social entrepreneurs who are already working in the CKD space. We want to encourage more innovation and co-creation with the Boehringer Ingelheim Making More Health initiative, together with our partners, to create an ecosystem of like-minded partners to address this very serious medical challenge. It is my hope that this funding call will attract as many as possible to like-minded social entrepreneurs working out there in the chronic kidney space to maximise their impact while maintaining sustainable business models.
Are you innovating in the kidney health space? We hope you'll apply to our funding call for the chance to receive funding, technical expertise and access to knowledge.
The interviewee, Dr. Gachanja David Kamau is Medical Affairs Manager at Boehringer Ingelheim in Sub-Saharan Africa. The content reflects his expert opinion and not necessarily the views of Boehringer Ingelheim in general.