Overcoming the challenges in setting up a renal registry in a sub-Saharan African country: Preliminary report on the Kenya Haemodialysis Registry

Résumé

Introduction: Haemodialysis (HD) is the most common kidney replacement therapy (KRT), yet over 90% of KRT patients reside in high-income countries and HD registries exist in only 12 African countries. The Kenya Renal Association established the Kenya Haemodialysis Registry to document, analyse and improve national HD services. We report its implementation and a preliminary epidemiological analysis of the first four months of data.
Methods: The registry is a prospective record of prevalent and incident HD patients treated nationally. Using consecutive sampling, patient data were captured on a digital questionnaire, anonymised immediately, and uploaded to cloud-based storage.
Results: Over four months from September 2024, 130 HD units (49% of those in Kenya) were approached; 16% declined and 20% had closed. Of 2193 patients registered, 65% were male. Estimated prevalence was 130 per million population (pmp) — 170 pmp in males and 91 pmp in females; a ±10% sensitivity analysis gave 117–143 pmp. Median age was 54.0 years, with only 22% younger than 40. A tunnelled catheter was the commonest vascular access (57%); 27% had an arteriovenous fistula. Over 95% received twice-weekly HD and over 90% were treated for anaemia, though more than half had been transfused. HIV positivity was 4.6%, hepatitis B 1.5% and hepatitis C 0.3%. Most patients (60%) had been on HD for 1–5 years and 6.6% for over five years.
Conclusions: This interim report demonstrates the feasibility of renal registries in Africa despite logistical challenges such as technical and ethico-legal constraints.