Glomerular diseases in South African patients on kidney replacement therapy: an analysis of 2022 South African Renal Registry data.

BACKGROUND: Kidney failure is a growing public health burden in sub-Saharan Africa, with limited access to kidney replacement therapy (KRT) and a paucity of epidemiological data, particularly on glomerular disease as an underlying cause. The primary aim of our study was to describe the types of glomerular diseases in prevalent patients receiving KRT in South Africa.

METHODS: We conducted a cross-sectional study of South African prevalent patients who were receiving KRT on 31 December 2022 who had glomerular disease as a cause of their kidney failure, as recorded in the South African Renal Registry (SARR). Patients were categorised by glomerular disease subtype, demographic data, KRT modality, sector of care and geographic distribution.

RESULTS: Of the 9342 patients on KRT, 2135 (22.9%) had glomerular disease as a cause of kidney failure. The median age was 55 years (interquartile range: 42-65 years), with a male predominance (56.9%). Secondary glomerular diseases accounted for 67.9% and diabetic nephropathy (56.1%) was the most common, followed by human immunodeficiency virus-associated nephropathy (4.8%) and lupus nephritis (4.5%). Of the primary glomerular diseases, focal segmental glomerulosclerosis (7.7%) was the most common, followed by IgA nephropathy (5.3%), rapidly progressive glomerulonephritis (4.8%) and mesangiocapillary glomerulonephritis (3.8%).

CONCLUSIONS: Nearly one-quarter of patients receiving KRT in South Africa have glomerular disease as a cause of their kidney failure, with secondary forms predominating. The high prevalence of diabetic nephropathy underscores the substantial contribution of diabetes mellitus to the burden of kidney failure. Marked disparities were observed between healthcare sectors.