Award-winning kidney specialist leads the fight against youth dialysis rates

Source: Supplied. Professor Rajendra Bhimma, who practises at Netcare St Augustine’s Hospital.

Based at Netcare St Augustine’s Hospital, Bhimma was recently awarded the Fellowship to acknowledge his extensive work in research, community-based outreach and teaching of paediatric nephrology, among others.

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 (UKZN) and is the chairperson of the KZN Renal Transplant Panel.

Bhimma, however, has no time to bask in the reflected glory of his many accomplishments. He is working hard to find answers to the many questions he has about several worrying kidney-related illnesses being experienced by South Africans. He explains one of these, saying that the average age of patients beginning dialysis in KwaZulu-Natal is just around 43 years.

By comparison, the average age of patients going into dialysis in the USA and Canada is between 62,5 years and up. “There, they have a geriatric population going onto 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 underway to determine why this is the case. We’re seeing a lot of children and teenagers going onto dialysis. We have to find out why.”

What does the achievement of the ISN Fellowship mean?

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. While thrilled at the news that he’d got the Fellowship, Professor Bhimma said he didn’t initially believe it.

“To be considered, you have to do groundbreaking, innovative research, not descriptive studies. They look at your training and teaching of paediatric nephrology to the larger community, and I’ve trained quite a few paediatric nephrologists. Then, they look at your community outreach and how you simplify everything and bring it to the community. For instance, I’ve done radio talk shows and talks at schools, religious gatherings as well as interest groups.”

Reka Dulandas, Netcare’s KwaZulu-Natal regional transplant manager, paid tribute to Bhimma, saying his expertise and contributions to kidney medicine are 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.”

She said Bhimma has shown unwavering dedication to the field of transplant medicine. “A valued advisor 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.

"Furthermore, his role as chairperson of the KZN Renal Transplant Panel highlights his leadership in driving improvements in renal care in the region, particularly in the area of kidney transplants.”

A change in plan

Bhimma 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 cheeked 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 the time I did a repeat stint in paediatrics, my friend’s dad, Dr Ronnie Pillay, told me he thought I should do 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, he began performing kidney transplants for children at King Edward Hospital. “Previously, we used to transplant adult patients only, and children in KwaZulu-Natal were referred to Johannesburg or Cape Town. Many patients were from poorer communities and couldn’t afford to go all the way there for the transplants they needed.

“My research in children with hepatitis B showed that a large percentage of affected children have a genetic mutation that predisposes them to kidney disease. We found that many of these children also had silent liver disease, which was quite severe. We were able to treat them, and the majority of them recovered.

"We didn’t only work on the pathogenesis of a disease. We also treated the disease. The biggest advance was the introduction of the hepatitis B vaccine in April 1994. Now that the vaccine is available, this disease will almost disappear."

In 2003, Bhimma started doing kidney transplants for children at Netcare St Augustine’s Hospital. “Fortunately, if we are able to treat them early, in many instances, we can defer a transplant until they are adults.”

Sharing his knowledge with new medical practitioners is very important to Bhimma. “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 much innovative work and looking at genetic studies in chronic kidney disease. We’re asking questions all the time. We must find the answers that are relevant to us here, and not to a different country, far away. We want to help our people at home. We owe that to our patients.”