Disparities in CKD burden and care in Kenya (computation of a renal health disparity index)

Background: Chronic kidney disease (CKD) represents a significant and growing global health challenge, accounting for 41.5 million years of life lost to premature death or disability in 2019. In low- and middle-income countries (LMICs) like Kenya, CKD burden is increasing amidst the ongoing epidemiologic transition. Despite this, systematic assessments of renal health inequities within Kenya are lacking.Objective: This study aims to address critical gaps by examining the distribution of CKD burden and healthcare resources, computing a Renal Health Disparity Index (RHDI) to highlight inequities, and providing targeted recommendations for reducing disparities.Methods: A comprehensive, paper-based assessment was conducted, leveraging data from the Global Burden of Disease study, national healthcare reports, and targeted literature searches. The RHDI was developed using four components: CKD-specific disability-adjusted life years (DALYs), dialysis unit density, nephrologist density, and core healthcare workforce density. Each element was weighted and normalised to compute county-specific disparity scores. The score ranges from 0 to 1; higher equals worse disparity. Key limitations include the lack of large-scale CKD prevalence estimates, unreliable data on diagnostic lab availability, insufficient epidemiological studies, and the absence of a functional CKD registry in Kenya. Results: Kenya's CKD prevalence increased from 3.06% in 1990 to 4.06% in 2021, with higher burdens observed among older adults and males. The distribution of healthcare resources is heavily skewed towards urban centres like Nairobi, which has 26 of the 41 nephrologists and 45 dialysis facilities. In contrast, counties such as Nyamira and Mandera lack nephrologists and dialysis units entirely. The RHDI analysis revealed significant disparities, with counties like Nyamira (0.92) and Nyandarua (0.76) exhibiting the highest inequities, while Nairobi (0.21) and Mombasa (0.54) had the lowest. Priority Interventions National CKD Registry: Establish a digital CKD registry to improve data collection on prevalence, treatment, and outcomes for evidence-based planning.Health Workforce Development:Expand nephrology training through the East African Kidney Institute.Introduce diploma courses in renal medicine for medical officers and nurses, focusing on equitable deployment to underserved areas.Renal Replacement Therapy (RRT):Promote Peritoneal Dialysis (PD) as a cost-effective, infrastructure-light alternative, especially in rural areas, with subsidies, local manufacturing, and training.Expand Hemodialysis (HD) facilities in rural counties through public-private partnerships.Strengthen renal transplantation programs by enhancing capacity at existing centers and creating new ones.Diagnostic Infrastructure: Invest in laboratory services in rural hospitals for early CKD diagnosis, including biochemistry and lipid profile testing.Focus on High-Disparity Counties: Prioritize counties with high RHDI scores, such as Nyamira and Nyandarua, for resource allocation and healthcare infrastructure improvements.Public Awareness and Prevention: Conduct community education campaigns on CKD risk factors, prevention, and early detection to reduce late-stage presentations.Research:Encourage studies on CKD epidemiology and cost-effectiveness of PD and HD.Investigate gender-related factors in care-seeking behavior among CKD patients.Conclusion: This study underscores substantial disparities in CKD burden and healthcare access in Kenya. Targeted interventions, including establishing a CKD registry, expanding nephrology training, and prioritising resource allocation to high-disparity regions, are essential to bridge these gaps. Further research on CKD epidemiology, cost-effectiveness of treatment modalities, and public awareness is recommended to inform sustainable policies and improve outcomes