Wits kidney disease expert brings African perspective to landmark Lancet papers
- Wits University
In Africa, chronic kidney disease may be missed due to limited screening and also as warning sign patterns can differ from those seen in high-income countries.
New screening and treatment policies, however, are possible.
This insight is one of the key perspectives brought by Dr June Fabian, a nephrologist and Director of the Wits Donald Gordon Medical Institute (at the WDGMC) at Wits University in Johannesburg, South Africa.
Fabian is the only contributor from Africa to a landmark Lancet series on chronic kidney disease (CKD). (See paper 3).
The three research papers also highlight differences in treatment and diagnosis between men and women, as well as the need for integrated approaches to CKD prevention and treatment across a range of healthcare settings.
CKD is a long-term condition in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. It currently affects an estimated 844 million adults worldwide and is projected to become the fifth leading cause of death by 2040.
Yet kidney disease is often silent.
In its mild and moderate stages, people may experience no obvious symptoms. Symptoms may appear only once the disease is advanced, close to the point when dialysis or a kidney transplant may be required. Without successful treatment, CKD can be fatal.
In many parts of the Global North, diabetes is a dominant driver of chronic kidney disease. In African settings, hypertension may be a more important warning sign, including among much younger people whose kidney damage may go undetected until the disease is advanced.
Currently, many primary healthcare nurses are not trained to think about kidney disease early.
However, Fabian explains that simple urine and blood tests can be integrated into primary healthcare clinics, where nurses and community health workers already screen for conditions such as HIV, hypertension and diabetes.
Moreover, many of the medicines which slow the progression of CKD are now available at a much lower cost.
In May 2025, the 78th World Health Assembly adopted the first-ever resolution on kidney health, recognising kidney disease as a growing global public health issue and calling oncountries to strengthen early detection, management, prevention, and equitable access to essential medicines and services.
Fabian says, “The resolution gives African health systems a way forward. CKD should not be seen as a late-stage specialist problem. We already have a template for community-based screening. With training, clear referral pathways and access to affordable treatment, primary healthcare workers can help identify kidney disease earlier.”
The Lancet series, authored by a global team of kidney experts and led by Dr Jennifer Lees from the University of Glasgow, calls for urgent action to improve the early diagnosis and treatment of CKD.
The Lancet papers call for greater use of simple, affordable tests — including urine testing for protein and blood testing for creatinine to estimate kidney function — to detect kidney disease earlier, before it becomes life-threatening.
Meanwhile, the experts highlight that currently around 30–50% of CKD cases are not diagnosed by a doctor in high-income countries, with the percentage of undiagnosed cases in middle- and lower-income countries thought to be much higher.
In some groups, the percentage of undiagnosed cases is particularly high: people of African descent and women may be up to twice as likely to remain undiagnosed as white men.
The Lancet papers also offer detailed insights into recent advances in CKD, including improved understanding of the disease and its consequences for global health, as well as new treatment strategies that can delay or reduce progression.
The new papers are released as up to 10,000 kidney experts arrive in Glasgow for the European Renal Association Congress from 3–6 June. Chaired by Congress President Dr Kate Stevens, honorary clinical senior lecturer at the University of Glasgow, and Congress Secretary Professor Patrick Mark, Professor of Nephrology at the University of Glasgow, the conference brings together kidney experts from around Europe to discuss a range of conditions, including CKD.
Dr Jennifer Lees, Senior Clinical Research Fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde, says, “Chronic kidney disease remains one of the most concerning conditions currently impacting global health. The overriding message from our series of research papers is that there remains a pressing need for attention and resources to be focused on this condition.”
Read the Lancet Series
Paper 1: Advances in the diagnosis and detection of chronic kidney disease
Paper 2: Advances in understanding the impact of sex on kidney health and disease
Paper 3: Chronic kidney disease, complex conditions, and advancing therapeutics: new hope and challenges
足球竞彩app排名 Dr June Fabian
Dr June Fabian is a nephrologist and clinical epidemiologist at the University of the Witwatersrand, Johannesburg, South Africa. She is the Director of the Wits Donald Gordon Research Institute at the Wits Donald Gordon Medical Centre (WDGMC). Her work focuses on chronic kidney disease in African populations, including CKD prevalence, risk factors, screening, diagnosis and the need for African evidence to inform policy and practice.