Nigerian Nephrologist Urges Urgent Kidney Care Reforms Amid Rising Disease Burden
A prominent transplant nephrologist and Medical Director of Abia State Specialist and Diagnostic Hospital, Dr. Chimezie Okwuonu, has issued a compelling call for immediate and comprehensive reforms in Nigeria's kidney care infrastructure. The physician delivered a stark warning that without enhanced financing, improved transplant facilities, and broader adoption of innovative therapies, the escalating number of kidney disease cases could continue to overwhelm both patients and the nation's healthcare sector.
Progress and Persistent Gaps in Kidney Transplantation
Dr. Okwuonu made this urgent appeal while presenting Nigeria's kidney transplant experience at an international nephrology conference. He detailed measurable progress in transplantation, noting that Nigeria now has 19 established transplant centers, with 11 actively performing procedures over the last three years. The country has conducted approximately 2,100 kidney transplants, with nearly 1,958 performed in private facilities and 142 in public hospitals. This marks a significant increase from the early years, when only 308 procedures were recorded between 2000 and 2016.
Between 2017 and 2026, the number of transplants surged to 1,892, with Nigeria currently performing between 160 and 190 kidney transplants annually. Dr. Okwuonu attributed this growth to expanding local expertise, international partnerships, and enhanced nephrology training. However, he emphasized that major structural challenges continue to severely limit access and outcomes for patients.
Financial Barriers and Patient Struggles
Funding remains one of the most formidable obstacles in kidney care. Transplantation costs range from $5,830 to $18,000 in public institutions and about $22,000 in private facilities, excluding the lifelong expenses of immunosuppressive drugs and post-transplant monitoring. This financial burden is driving many kidney patients to adopt medically unsafe coping strategies, such as reducing dialysis frequency.
Dr. Okwuonu had previously warned that patients with end-stage kidney disease cannot survive on just one dialysis session per week, noting that many resort to this inadequate schedule solely due to affordability issues. He disclosed that approximately 88 percent of kidney patients who require transplants are unable to proceed because of cost, underscoring the critical need for stronger insurance support and government intervention.
The nephrologist called for the National Health Insurance Authority to expand coverage to include transplant procedures and post-transplant care, arguing that out-of-pocket payments have rendered renal care inaccessible to a vast number of Nigerians.
Challenges in Transplant Outcomes and Infrastructure
Dr. Okwuonu also expressed concern over increasing transplant failures in Nigeria, linking them to poor medication adherence, weak post-transplant monitoring, laboratory constraints, and the inability of many recipients to sustain long-term care. Improving outcomes will require strengthening Human Leukocyte Antigen laboratories, increasing access to specialized diagnostics, and establishing a unified national transplant registry.
According to figures he presented, Nigeria has about 300 consultant nephrologists, with only about 30 actively involved in acute transplant care, while the number of transplant surgeons remains around 40. The shortage of trained personnel, exacerbated by brain drain, continues to hinder the expansion of transplant services.
Innovations and Global Recognition
Despite these constraints, Nigerian specialists have achieved notable breakthroughs. Dr. Okwuonu cited the successful third kidney transplant performed in a Nigerian center on a 44-year-old man who had previously lost two grafts abroad as evidence of growing local competence in managing highly complex cases.
He also highlighted therapeutic apheresis, a blood-cleansing therapy promoted by researchers, as a major innovation capable of improving transplant outcomes. This therapy has emerged as a game-changer in managing antibody-mediated rejection and enabling incompatible transplants previously considered difficult. Recent research involving 131 patients and over 860 procedures has further validated its promise in kidney transplantation.
Dr. Okwuonu, recently elected to the board of the International Society for Apheresis, stated that this position offers an opportunity to advance access to such therapies in Africa and influence global guidelines relevant to low-resource settings. His election followed shortly after a US-based Nigerian professor became the society's first Black president, developments that stakeholders describe as significant milestones for African representation in global kidney care leadership.
Call for Comprehensive National Renal Care Policy
Drawing from the experience of the Federal Medical Centre in Umuahia, which he described as the pioneer transplant center in the South-East serving over 25 million people, Dr. Okwuonu noted that long-term complications observed in local practice include chronic rejection, recurrent kidney disease, infections, and death. These realities reinforce the need to move beyond performing surgeries to building sustainable systems for long-term transplant survival.
He identified strengths in Nigeria's transplant journey, such as international partnerships, growing multidisciplinary teams, increased nephrology capacity, and emerging expertise in apheresis. However, funding gaps, supply chain instability affecting transplant drugs, limited laboratory support, and the absence of a deceased donor program remain major barriers.
Dr. Okwuonu called for a comprehensive National Renal Care Policy that would include mandatory funding for transplant infrastructure, support for research, decentralized dialysis and transplant satellite centers, and legislative reforms to support deceased donor transplantation. He emphasized that Nigeria must also invest in primary care nephrology to improve early detection of chronic kidney disease and reduce progression to kidney failure.
The country should target universal renal coverage involving dialysis and post-transplant care while pursuing a stronger deceased donor program within the next five years.
Broader Health Policy Advocacy
Beyond transplantation, Dr. Okwuonu has been vocal on wider health policy issues. He was among stakeholders who criticized proposals to compel public servants to use only public hospitals, arguing that such measures cannot fix Nigeria's broken health system without addressing underfunding and infrastructure decay. Meaningful reform, he asserted, should focus on rebuilding public hospitals and strengthening accountability rather than imposing restrictions.
His interventions come amid broader concerns in the health sector, including repeated tensions between doctors and the government over welfare issues, which recently led the Nigerian Medical Association to suspend a planned strike after granting the Federal Government a fresh ultimatum.
Path Forward and Collaborative Efforts
Observers note that Dr. Okwuonu's advocacy increasingly combines clinical innovation, policy engagement, and systems reform. In his presentation, he urged the government, private sector actors, and international bodies to deepen collaboration to close remaining gaps in kidney care. He also called on global institutions to support resource-sensitive guidelines that reflect the socio-economic realities of practicing nephrology in sub-Saharan Africa.
For Dr. Okwuonu, the progress recorded so far demonstrates that kidney transplantation can succeed in Nigeria if backed by stronger policy and investment. "We have made progress through local innovation, partnerships, and resilience, but sustaining and expanding those gains will require deliberate reforms," he stated.
As chronic kidney disease continues to rise and more Nigerians struggle with the high cost of renal care, experts assert that the reforms championed by Dr. Okwuonu and other stakeholders may prove critical to the future of kidney health in the country.
