What is Uganda doing to combat the Chronic Kidney Disease epidemic?

As the world marked World Kidney Day on March 13, Uganda found itself grappling with a silent but deadly health crisis. Chronic Kidney Disease (CKD) is on the rise, claiming lives and leaving many families in financial ruin. Despite recent milestones, such as successful kidney transplants at Mulago National Referral Hospital, the country’s healthcare system is struggling to keep pace with the growing demand for treatment. With dialysis costs soaring and more than 100 patients awaiting transplants, the question looms large: Is Uganda doing enough to combat this silent epidemic?

This year’s World Kidney Day theme, “Kidney Health for All,” serves as a stark reminder of the urgent need for early detection, accessible treatment, and sustainable transplant programs. However, with limited funding and a surge in hypertension and diabetes; the leading causes of kidney failure, Uganda’s fight against CKD is far from over.

A young boy’s battle

Jaydon Tyler Ssesanga, a 16-year-old kidney disease patient, embodies the struggles faced by many Ugandans. In 2022, what began as a routine case of malaria quickly spiraled into a life-threatening situation. Despite treatment, Ssesanga’s condition worsened, and he was diagnosed with kidney failure, likely triggered by the infection.

“His whole system was almost shutting down,” recalls his mother. “He looked so pale, and the doctors said his kidneys were failing.” Ssesanga’s condition was initially managed with medication and a strict diet, but his kidney function continued to decline. By 2023, he was on dialysis; a grueling and expensive process that drained the family emotionally and financially.

“I hated seeing him go through dialysis,” his mother says. “He was restricted from eating most of his favourite foods, and the process was exhausting.”

Ssesanga’s father offered to donate a kidney, but could not even afford the costs of pre-transplant tests alone which amounted to Shs10m.

Fortunately, MTN, where Ssesanga’s mother works, covered the expenses. After a delayed procedure due to high blood pressure, Ssesanga finally received his transplant on March 15, 2024, at Aga Khan Hospital in Kenya. Today, he is recovering and no longer requires dialysis. However, he must take immunosuppressants for life to prevent organ rejection; a reminder that the battle against CKD is often a lifelong journey.

The silent epidemic

Chronic Kidney Disease is a growing public health concern in Uganda, mirroring a global trend. CKD impairs the kidneys’ ability to filter waste and excess fluids, leading to severe complications if left untreated. Globally, CKD affects approximately 10 percent of the population, with many unaware of their condition due to its asymptomatic nature in early stages.

In Uganda, comprehensive national data is scarce, but regional studies indicate a rising prevalence, particularly in urban areas where lifestyle changes have fueled hypertension and diabetes; the primary risk factors for CKD.

Dr Robert Kalyesubula, a nephrologist at Nakasero Hospital, reveals that younger populations are increasingly at risk due to sedentary lifestyles and unhealthy diets.

“As we age, our kidney function naturally declines,” Dr Kalyesubula explains. “It is crucial for people over 40 to routinely check their kidney health.”

He also highlights other risk factors, including infections like malaria and HIV, genetic abnormalities, and conditions such as sickle cell disease and cancer.

Treatment options

CKD progresses through five stages, determined by the glomerular filtration rate (GFR), which measures kidney function. Early stages (1 and 2) often require lifestyle changes and medication to manage symptoms and slow progression. However, advanced stages (4 and 5) necessitate dialysis or transplantation.

In Uganda, hemodialysis is the most common treatment, typically requiring three sessions per week at a cost of Shs400,000 per session. Peritoneal dialysis, a more convenient option for children, is rarely used due to a lack of supplies and sterile conditions.

Kidney transplantation, while offering a better quality of life, remains out of reach for many. The procedure costs approximately Shs150m, excluding travel and accommodation expenses, as most transplants are performed abroad.

Challenges

Uganda has made significant strides in kidney care, including the establishment of dialysis centres and successful kidney transplants at Mulago Hospital. In November 2024, a collaborative team of Ugandan and Indian medical experts conducted four kidney transplants, bringing the total number of such procedures in the country to five.

However, challenges persist. More than 100 patients are currently awaiting transplants, hindered by the government’s failure to allocate Shs7.2b needed to operationalise the Uganda Organ Donation and Transplant Council. This council is critical for regulating transplant activities and ensuring ethical practices.

Mulago Hospital has also requested an additional Shs8.6b from Parliament to expand its transplant services.

 “While we have achieved significant milestones, financial and regulatory challenges remain,” says Dr Kalyesubula. “Addressing these issues is essential to provide timely and affordable care.”

The cost of dialysis

The financial burden of dialysis is immense. For many families,  the cost of the weekly sessions totals to Shs1.2 million which is about Shs4.8 million per month, is unsustainable. This often forces patients to choose between treatment and other essential needs, leading to devastating consequences.

Beyond the financial strain, dialysis takes a toll on patients’ quality of life. Many experience emotional stress, loss of employment, and social isolation. For children such as Ssesanga, the process is particularly challenging, requiring immense resilience and support from their families.

Prevention

Preventing CKD requires proactive measures, including healthy lifestyle choices and early detection of risk factors. Dr. Kalyesubula emphasizes the importance of a balanced diet rich in fruits, vegetables, and whole grains, while limiting salt, sugar, and processed foods. Regular physical activity, adequate hydration, and avoiding smoking and alcohol are also crucial.

“Early detection of hypertension and diabetes is key,” he says. “Routine check-ups can help identify kidney problems before they progress to advanced stages.”