Dialysis patients in KwaZulu-Natal are 20 years younger than the norm in America and Canada, and the reasons for this conundrum are what keeps highly respected Durban paediatric nephrologist Professor Rajendra Bhimma awake at night and ahead of the pack in his field.
Bhimma, based at Netcare St Augustine’s Hospital, has just been globally acknowledged for his pioneering research and work, having been instrumental in developing best practices in paediatric nephrology, and widely commended for his unwavering dedication to transplant medicine.
The status of Fellow of the International Society of Nephrology (FISN) indicates professional excellence to both the recipient’s peers and patients, as well as medical professionals worldwide.
Bhimma, who said he was thrilled at the news, is currently immersed in trying to find answers to the many questions he has about kidney-related illnesses among South Africans, and the increase in younger patients.
The average age of patients beginning dialysis in KwaZulu-Natal is around 43-years-old. By comparison, the average age of patients going into dialysis in the USA and Canada is 62.5 and older.
There are no clear reasons for this, he said.
“There, they have a geriatric population going on to dialysis. Here, we have young people at the most productive stage of their lives with stage five chronic kidney disease. We don’t fully understand it, but studies are under way to determine why we’re seeing so many children and teenagers going on to dialysis. We have to find out why.”
On his Fellowship, Bhimma was modest: “To be considered, you have to do ground-breaking, innovative research, not descriptive studies. They look at your training and teaching of paediatric nephrology to the larger community – I’ve trained quite a few paediatric nephrologists. They also look at your community outreach and how you simplify everything and bring it to the community.”
Reka Dulandas, Netcare’s KwaZulu-Natal regional transplant manager, said Bhimma’s expertise and contributions to kidney medicine were widely recognised.
“His dedication to advancing medical knowledge and improving patient outcomes is evident not only in his clinical work, but also in his significant roles in academia. As a committed educator and researcher, he has been instrumental in developing best practices in paediatric nephrology.”
A valued adviser on the Transplant Ethics and Advisory Committee for Netcare, his deep understanding of ethical considerations and patient care helps maintain the highest standards in transplant procedures, she added.
Among his other portfolios, he also heads up the Paediatric Kidney Clinical Unit at Inkosi Albert Luthuli Central Hospital, which is affiliated with the University of KwaZulu-Natal, and is chairperson of the KZN Renal Transplant Panel.
Change in career
The nephrologist began his career in internal medicine in adults, but this was not where he would end up making his mark on the medical world.
“Originally, I wasn’t going to become a paediatrician. The shift in my career happened surprisingly. In my final exam, I contradicted my examiner because I knew I was right and he was wrong. But he didn’t like that, so he failed me, and I had to repeat six months of my training.
“During that time while I did a repeat stint in paediatrics, my friend’s dad, Dr Ronnie Pillay, told me he thought I should stick with paediatrics. ‘You’ll never go wrong,’ he said.”
Bhimma went to Canada to complete his super-specialist training in kidney disease in children, and when he returned, began performing kidney transplants for children at King Edward Hospital.
“Previously, we would transplant adult patients only, and children in KwaZulu-Natal were referred to Johannesburg or Cape Town. But many patients were from poorer communities and couldn’t afford to go all the way there for the surgeries.”
Hepatitis B
He said his PhD thesis had been on nephropathy associated with the hepatitis B virus.
“Professor Miriam Adhikari, one of my supervisors, had made an interesting observation. While Indian and white children and those of mixed race responded very well to steroid treatment for nephrotic syndrome, many black children did not.”
Later, he became involved in innovative studies which showed that one of the reasons black children do not respond to steroids is because they have a mutation in a particular gene. “We found out why the steroids weren’t working, that many of them also had silent liver disease, which was quite severe. We were able to treat them – and most of them recovered. We don’t only work on the pathogenesis of a disease, we also treated the disease.
“If we are able to treat them early, in many instances we can defer a transplant until they are adults.”
He said the biggest advance had been the introduction of the hepatitis B vaccine in April 1994. “Now that the vaccine is available, this disease will almost disappear.”
In 2003, he began doing paediatric kidney transplants at Netcare St Augustine’s Hospital.
Kidney disease, he added, was on an exponential rise. “According to WHO data on non-communicable diseases, in 2005, kidney disease did not make the top 20. By 2013, it was at number 16 or 17. In 2021, it was at number nine, and by 2040, we expect it to be at around number five on the list.”
Sharing his knowledge with new medical practitioners is very important to him.
“Research dictates clinical practice. Science is constantly being evaluated and changing. From the existing research, we see that what’s applicable in high-income countries may not be applicable to us. We’re doing a lot of innovative work and looking at genetic studies in chronic kidney disease, asking questions all the time.
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New vaccines offer hope for Hepatitis B treatment in SA