Chronic Kidney Disease in South Africa: Scoping Review of Epidemiology, Challenges, and Future Directions

Background:Chronic kidney disease (CKD) is an emerging epidemic in South Africa, reflecting the intersection of communicable and non-communicable disease burdens.The estimated prevalence of CKD ranges between 6% and 17% of the adult population, though nationallevel data remain sparse due to the absence of a renal registry.The major drivers of CKD in South Africa include hypertension, diabetes, Human Immuno deficiency Virus (HIV) infection, and genetic predispositions, with disproportionate effects on populations in low-resource settings.CKD outcomes are worsening, exacerbated by limited access to renal replacement therapy, late diagnosis, and systemic inequities between public and private healthcare sectors.This review synthesizes epidemiological evidence from South Africa and situates it within the sub-Saharan African context. Methods:This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, searching from PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2010 and 2025.A total of 520 records were identified; 70 duplicates were removed, and 450 were screened.Of these, 120 underwent full-text review, with 45 meeting the inclusion criteria. Results:Results highlight current preventive and management practices, systemic challenges, and the implications of the forthcoming National Health Insurance (NHI) reforms.Dialysis services are concentrated in urban centers.The private sector provides ~70% of dialysis services, while the public sector rations are due to funding constraints.Only ~20% of End stage kidney disease (ESKD)patients have access to dialysis, compared to near-universal access in high-income countries.Kidney transplantation is performed in a few tertiary hospitals.Annual transplant numbers range from ~250 to 300, which are insufficient for demand.Poverty, limited healthcare access, and health system inequities contribute to delayed diagnosis and poor outcomes. Conclusions:Without urgent and targeted reforms, CKD will remain a major and inequitable contributor to South Africa's disease burden.Recommendations include strengthening national surveillance, integrating CKD screening into primary care, expanding dialysis and transplant capacity, enhancing public awareness, and investing in rural healthcare infrastructure.