Author: Dr. Reham Hussein | Nephrologist
At many health facilities, patient forms queue up daily for kidney dialysis appointments. Many patients are diagnosed at advanced stages of kidney disease — particularly stages four and five — which are the most dangerous and require urgent medical attention.
Data from the Ministry of Health and international organisations estimate that approximately 13 percent of Uganda’s population is affected by kidney disease. In a previous interview, Health Minister Dr Ruth Aceng confirmed that renal diseases in the country range from mild to severe cases.
By December 2023, the Ministry reported over 1,000 cases of end-stage kidney disease requiring dialysis, with Mulago National Referral Hospital handling the majority.
According to Dr Reham Hussein, a consultant nephrologist at UMC Victoria Hospital, kidney disease has become a major national health concern. The hospital receives between 25 to 30 patients each week for kidney dialysis.
Dr Reham explains that kidney disease falls into two broad categories: acute kidney injury and chronic kidney disease (CKD). Acute kidney injury refers to a sudden decline in kidney function that prevents the kidneys from filtering waste. However, in over 95 percent of cases, if the underlying cause is treated, kidney function can return to normal. Chronic kidney disease, on the other hand, is a progressive and often irreversible decline in kidney function that develops over time, usually remaining silent in its early stages. To be classified as CKD, abnormalities must persist for at least three months.
“In most cases, the symptoms remain silent until the disease progresses to stage three or four, which is why we always try to increase awareness,” Dr Reham said.
She notes that many patients are referred from across Uganda and neighbouring countries such as the Democratic Republic of Congo, Rwanda, and South Sudan. While acute kidney issues can often be treated and resolved, chronic kidney disease becomes a lifelong condition requiring ongoing management, dialysis, or eventual transplantation.
Treating CKD comes at a high cost. In private hospitals across Uganda, dialysis typically costs between Shs250,000 to Shs300,000 per session, with patients requiring three to four sessions weekly. This translates to Shs750,000 to Shs1 million per week, not including the cost of medication.
Dr Ramin Matin Tavakoli, Director of UMC Victoria Hospital, acknowledges that many patients cannot afford these expenses and are often left without lifesaving treatment. In response, the hospital, supported by donors, rolled out a Corporate Social Responsibility (CSR) initiative that subsidises dialysis costs, charging patients Shs150,000 per session — a significantly lower fee than the national average.
“While dialysis remains expensive, this programme — supported by donors — has made treatment more accessible to many patients who would otherwise have no option,” Dr Ramin said.
Although anyone can develop kidney disease, Dr Reham emphasised that certain groups face higher risks. These include diabetics, patients with hypertension or cardiac conditions, HIV-positive individuals, and older men with urinary tract obstructions. She advises individuals in these categories to undergo routine kidney function tests, ultrasound scans, and urine analyses to detect any early signs of kidney impairment.
Unfortunately, many patients seek medical help when the disease has already progressed significantly. “Our goal is to identify kidney issues as early as possible to manage them effectively before they advance to stage five, where dialysis becomes inevitable,” she explained.
Once a patient reaches stage five, medical treatment alone is no longer sufficient. At this point, renal replacement therapy is required. There are three primary options: haemodialysis, in which blood is filtered through a dialysis machine two to three times a week, mimicking the kidney’s natural function; peritoneal dialysis, a less common alternative where the abdominal lining is used to filter blood; and kidney transplantation, the most definitive treatment option, where a healthy donor kidney replaces the failing organ.
Dr Reham describes haemodialysis as “an artificial kidney that removes waste products, balances electrolytes, and eliminates excess water from the body.”
Because CKD is often silent in its early stages, Dr Reham urges people with diabetes, hypertension, heart disease, or HIV to check their kidney function at least twice a year.
“Early detection allows us to reverse damage in some cases, especially among diabetic patients, and prevent progression to advanced stages,” she said.
She also warns against the misuse of over-the-counter medications, particularly painkillers and antibiotics, which can damage the kidneys when taken without proper medical supervision.
“Please don’t self-medicate. Always consult a doctor. Even if you feel healthy, check your blood pressure and kidney function periodically,” she advised.
If both dialysis options fail, kidney transplantation becomes the only remaining solution. Dr Reham explains that careful medical assessments are conducted to ensure that both the donor and recipient are suitable candidates for the procedure.
“Transplantation preparation is critical. We must ensure the donor is healthy, unlikely to develop kidney disease later, and that the recipient is medically fit to accept the new kidney with minimal risk of complications,” she said.
Post-transplant care also requires lifelong medication and monitoring to ensure the transplanted kidney remains healthy and functional.
Bottom line: Kidney disease is a serious but often preventable health condition. Early detection, regular check-ups, proper management of existing health conditions, and responsible medication use can all help protect your kidneys — and save lives.
