A CKD diagnosis can be frightening. Words like 'kidney failure' and 'dialysis' may come to mind. The first thing to know: most people diagnosed with CKD are at an early stage where the right management can slow or even halt progression significantly. You have more control than it might feel right now.
The second thing: your kidneys are doing a job your body entirely depends on. A CKD diagnosis means you now have to become a partner in protecting them. That's entirely possible.
What to Do Right Now: Five Steps
Step 1 — Find out your CKD stage
CKD is staged 1–5 based on your eGFR (estimated glomerular filtration rate) and other markers like urine albumin (a sign of kidney damage). Your doctor should tell you your stage. It matters enormously — Stage 1 CKD and Stage 4 CKD are managed very differently and have very different trajectories.
If you don't know your eGFR or haven't had a urine albumin-to-creatinine ratio (uACR) tested, ask your GP to order these now. These two tests are the cornerstone of CKD staging.
Step 2 — Get referred to a nephrologist
A nephrologist (kidney specialist) should review your case at CKD Stage 3 or earlier if there is rapid progression. Your GP may manage early CKD well, but a nephrologist will establish whether your CKD is likely to progress, what the underlying cause is, and whether there are specialist interventions that will protect your kidneys.
Under the CDL, nephrology consultations are PMB-funded when clinically indicated. Register for CDL benefits (see Step 3).
Step 3 — Register for CDL benefits with your scheme
Contact your medical scheme and register CKD as a chronic condition under the Chronic Disease List (CDL). This unlocks dedicated chronic benefits: nephrology consultations, relevant medications (ACE inhibitors, ARBs), and monitoring blood tests. Ask your GP or nephrologist to complete the CDL registration form.
Step 4 — Find out your scheme's dialysis network — now, not later
This sounds premature if you're at Stage 1 or 2. It's not. If your CKD progresses to Stage 5 (ESRD), you will need dialysis. Which dialysis provider your scheme uses (their 'designated service provider' or DSP) is the most important coverage detail for CKD patients. Out-of-network dialysis generates a significant co-payment. You want to know this long before you need it.
Ask your scheme: "Which dialysis network do you use? Is it Advanced Renal Care (ARC) or National Renal Care (NRC), or another?" Note the answer. If you can choose a scheme at the next open enrolment period, factor in the dialysis network.
Step 5 — Control blood pressure and blood glucose as if your life depends on it (it does)
The two biggest drivers of CKD progression are uncontrolled blood pressure and uncontrolled blood glucose. Target blood pressure < 130/80 mmHg. If you have diabetes, tight glucose control (HbA1c < 7%) dramatically slows nephropathy. Your nephrologist may also recommend an SGLT-2 inhibitor (dapagliflozin/Forxiga) which has a proven renoprotective effect independent of diabetes.
Your Most Important Questions, Answered
Will I definitely end up on dialysis? No. Many people with early-stage CKD never reach Stage 5. With proper blood pressure control, RAAS blockade, and lifestyle management, progression can be significantly slowed. Some patients reach Stage 3 and remain there for decades.
What is dialysis and how bad is it? Dialysis replaces kidney function. In-centre haemodialysis means three sessions per week at a dialysis unit, each about 4 hours. It is time-consuming and life-changing. Peritoneal dialysis can be done at home, including overnight with an automated machine. Neither is pleasant, but thousands of South Africans live full lives on dialysis. It is not the end.
Can I get a kidney transplant instead? Transplant is the best long-term outcome for ESRD. It is PMB-funded including the surgery and lifelong post-transplant immunosuppression. Waiting lists are long, and not everyone is a candidate. A nephrologist will advise on transplant eligibility and workup.
What does my scheme cover? Under the CDL, your scheme must fund: RAAS blockers (ACE inhibitor/ARB), ESA therapy for CKD anaemia (through managed care), nephrology visits, and — if you reach Stage 5 — dialysis at the designated network and renal transplant.
How often do I need to see the doctor? Frequency depends on stage. Stage 1–2: annual nephrology review, quarterly kidney function and urine tests. Stage 3–4: every 3–6 months. Stage 5 (dialysis): your dialysis team monitors you continuously.
The Next Three Months
| Timeline | What Happens |
|---|---|
| Week 1–2 | Full baseline bloods: eGFR, uACR, FBC, electrolytes, phosphate, parathyroid hormone. CDL registration submitted. |
| Month 1 | Nephrologist first consult — cause identification, progression risk assessment. Blood pressure target set. |
| Month 2 | Diet review with renal dietitian. Medication optimised (RAAS blockade). |
| Month 3 | First monitoring blood test. Viral load assessment if HIV-positive (HIV nephropathy). |
Your Scheme Coverage for CKD
All CDL-registered schemes must fund conservative CKD management including RAAS blockade, monitoring, and nephrology. For ESRD: dialysis is PMB-funded in-network, and renal transplant is PMB-funded in full.
The critical financial risk: choosing the wrong scheme for dialysis coverage. If your scheme's DSP dialysis network is inconveniently located or underresourced, the impact on your quality of life is severe. For patients with progressive CKD, SCHEME selection (not plan selection) is the priority conversation. The Check sets the schemes side by side, and Eldon advises from there.
Ready to check your kidney disease cover in detail? Run your AURA check