Determinants of Kidney Transplantation Uptake Among Hemodialysis Patients in Gaborone, Botswana

Abstract

Chronic kidney disease (CKD) is a growing health concern globally, with a disproportionate burden in low- and middle-income countries, including Botswana, where prevalence exceeds global averages. Although hemodialysis (HD) is the most commonly used form of renal replacement therapy (RRT), evidence consistently shows that kidney transplantation (KT) is more cost-effective, improves quality of life, prolongs survival, and enhances economic productivity. Despite Botswana’s provision of fully subsidized RRT services—including HD, peritoneal dialysis (PD), and KT—transplantation remains underutilized. This study assessed the determinants of KT uptake among HD patients in Gaborone, Botswana. A cross-sectional study was conducted among 163 HD patients sampled proportionally across three dialysis centres in Gaborone. Data were collected using structured questionnaires on socio-demographic, patient-related, and healthcare factors. Descriptive statistics summarized participant characteristics, while chi-square tests and linear probability regression were employed to identify predictors of KT uptake. Only 17.2% of participants had initiated the transplantation process, indicating low uptake despite available services. Bivariate analysis demonstrated significant associations between gender, educational attainment, donor availability, and provider-related factors (education and referral) with KT uptake. In the multivariate regression model, age, donor availability, and referral by healthcare providers remained independent predictors (p < 0.05). Patient knowledge, comorbidities, and cultural or religious beliefs were not significantly associated. The most cited barriers were lack of a suitable donor (39.4%) and inadequate information (33.6%). Kidney transplantation uptake among HD patients in Gaborone remains low, with most patients not progressing in the transplant pathway. Donor availability, age, and provider referral emerged as key determinants, underscoring the urgent need to strengthen referral systems, improve patient education, and expand donor options to enhance access to transplantation.