Economic cost of end-stage renal disease in Africa: a systematic review

Chronic kidney disease (CKD) is a progressive and irreversible condition that contributes substantially to global morbidity and mortality. In Africa, the burden of CKD is compounded by limited healthcare resources, poverty, and the dual challenge of communicable and non-communicable diseases. The economic impact of end-stage renal disease (ESRD) is considerable, yet evidence from the region remains scarce.

This systematic review, conducted in accordance with PRISMA 2020 guidelines, examined the economic burden of ESRD in Africa. Data were extracted on study characteristics, patient populations, cost components, and financing mechanisms. All reported costs were standardized to 2025 USD.

Eighteen studies, involving 2,634 patients, were included. The majority received haemodialysis (HD) (95.9%), with limited data on peritoneal dialysis (PD) (2.7%) and kidney transplantation (1.4%). Annual HD costs varied widely, from $2,003.48 in Burkina Faso to $41,957.69 in South Africa, with a pooled median of $18,741.00. PD costs, reported in three studies, ranged from $11,161.98 in Egypt to $47,837.05 in South Africa. First-year transplantation costs plus follow-up varied between $33,120.18 in Cameroon and $46,293.59 in Nigeria. Direct medical costs dominated expenditures, with drugs and laboratory investigations representing major cost drivers.

Renal replacement therapy in Africa is costly, heterogeneous, and predominantly financed out-of-pocket. These findings highlight profound affordability challenges and underscore the urgent need for financial protection strategies, expanded insurance coverage, and sustainable models of kidney care.