African Journal of Nephrology

Editorial note: Welcome to the year 2025 and Volume 28 - Time to detect kidney disease and protect our kidneys

Alain G Assounga — Mon, 10 Mar 2025 00:00:00 +0000

On behalf of the African Journal of Nephrology (AJN) editorial board, I thank all the contributors and readers and wish everyone a very productive 2025.

In July 2024, AJN reached a significant milestone by achieving accreditation with CAMES (Conseil Africain et Malgache pour I’Enseignement Supérieur). AJN publications are now accepted for the evaluation of academics from Frenchspeaking African countries. The CAMES accreditation will, therefore, encourage the submission of articles in French. We look forward to receiving, evaluating, and publishing more French manuscripts.

Volume 27 included many highlights. An editorial by Luyckx et al. focused on the need to translate knowledge into action to improve kidney care. Several original articles reported on research on kidney diseases in various parts of Africa. I wish to mention the publication on living kidney donors, a report on CKD screening on World Kidney Day in Nigeria and a publication on acute kidney injury in Zambian children. Finally, a report on the South African Renal Registry summarised the latest data on the treatment of kidney failure in South Africa.

Last year, we proposed that society and the nephrology community should support individuals in taking primary responsibility for their kidneys. Education programmes which ensure the provision of appropriate information would yield better outcomes [1]. Taking a leaf from HIV management, large-scale educational activities could empower patients and improve treatment adherence. HIV is the third-leading cause of CKD in the province of KwaZulu-Natal, South Africa; hence, strategies to detect CKD and delay CKD progression need to be incorporated in HIV clinics [2].

I am impressed to note that patients living with HIV know their viral load and CD4 counts. They are, therefore, empowered to take their treatment seriously to maintain or improve the control of HIV and immune function. Similarly, I invite everyone to check and take note of their eGFR and proteinuria status annually, as these are key markers of kidney health. Half of the work is done by knowing the kidney’s health status. The nephrology community should contribute by supporting individuals in managing and improving the above parameters.

On March 13, 2025, the world will celebrate World Kidney Day. This year, the theme is “Are your kidneys ok? Detect early, protect kidney health”. Therefore, let us move to detect kidney disease early and protect our kidneys.

Extent of depression among dialysis patients in Africa: a scoping review

Siyanda A Ngema, Tshiamo N Ramalepa — Thu, 13 Feb 2025 10:56:40 +0000

Background: The diagnosis of kidney failure has a significant impact on the quality of life of dialysis patients in various healthcare-related aspects, potentially leading to the development of depression and anxiety. Conversely, depression and the effects of dialysis adversely affect caregivers and families of dialysis patients. These patients experience depression for a variety of reasons, including the psychological effects of chronic illness, lifestyle constraints, and the physical difficulties of therapy. Research on the prevalence and effect of depression in dialysis patients in Africa is limited, highlighting the need for comprehensive studies to address them. This study synthesizes current evidence on depression among dialysis patients in Africa using a scoping review.
Method: A systematic review of articles in PubMed, EMBASE, PsycINFO, African Journals Online (AJOL), and the Cochrane Library was conducted using keywords related to depression, dialysis, and renal disease in Africa, listing studies published between 2014 and 2024. A Microsoft spreadsheet was used to record the details of selected studies. Thirteen surveys met the criteria for final review, which followed the PRISMA-ScR guidelines, descriptive analysis and thematic analysis.
Results: We found that the prevalence of depression in African dialysis patients ranged from 32.4% to 80%, depending on the country and study population. This evidence was categorised into four main themes: mental health and quality of life; socio-economic and treatment factors; self-management and psychosocial support; and geographic, cultural, and clinical implications. The limited number of peer-reviewed research papers identified is of concern, considering the topic’s significance and growing importance.
Conclusion: Depression is prevalent among patients undergoing renal replacement therapies, such as haemodialysis and peritoneal dialysis. Regular assessments of depression are crucial for new dialysis patients to ensure early detection and optimal intervention. Further research is needed to improve the screening, diagnosis, and management of depression among dialysis patients in Africa.

Peritoneal dialysis in a crisis: Navigating a severe drought and pandemic in South Africa

Fri, 18 Apr 2025 09:05:51 +0000

Background: A severe drought, followed by the COVID-19 pandemic, posed significant challenges to a South African peritoneal dialysis (PD) programme in Cape Town. The study reported here assessed the impact of these crises on peritonitis rates, bacterial organisms cultured, and patient and technique survival.
Methods: This observational cohort study used data from a peritoneal dialysis registry from 2007 to 2022. The study population was categorized according to three periods: “Baseline” (2007–2014), “Drought” (2015–2019), and “COVID-19” (2020–2022). Baseline characteristics were recorded when PD began. Trends in peritonitis rates, organisms cultured and causes of technique failure were evaluated during each period. A drought-specific questionnaire explored water quality and source.
Results: The cohort comprised 405 patients, representing 559 peritonitis events. There was no statistical difference overall in peritonitis rates, nor peritonitis-free survival at one year among the three periods. Despite Gram-positive organisms being the predominant species cultured, there was an increasing trend in Gram-negative peritonitis during the drought (24%, 46/195) compared to baseline (16%, 37/230) and COVID-19 (15%, 20/134) periods. Klebsiella pneumoniae was the predominant Gram-negative organism cultured overall. However, there was a rise in the proportion Escherichia coli cultured in the drought (17%) compared to the pre-drought (3%) periods. The proportion of Gram-negative catheter-related infections increased during the drought and COVID-19 periods (P = 0.001), with a predominance of Pseudomonas aeruginosa. Only 18% of patients boiled their water as instructed.
Conclusion: The similarity in overall peritonitis rates for the three periods highlights the adaptability and sustainability of peritoneal dialysis as a treatment option, especially at a time of increasing environmental and public-health crises.

Acknowledgement to reviewers 2024

M Razeen Davids — Mon, 17 Mar 2025 00:00:00 +0000

The editors of AJN wish to thank the colleagues who generously gave of their time and expertise to review manuscripts for us during 2024. We greatly appreciate their contribution to the quality of the work that we publish.