The short answer: KRACON 2026, the Kenya Renal Association's annual scientific conference, ran from 23 to 26 September in Mombasa under the theme "Kidney Health: Beyond Nephrology". Its biggest moment was the launch of Kenya's first national kidney guidelines. For dialysis units, the practical themes were treatment adequacy, access, data and the cost of water and energy.

Nanto Med attended KRACON 2026, and through our Conference Fellowship we sponsored two renal nurses to attend. This post shares what we took away for the people who keep dialysis units running: unit managers, renal nurses and biomedical engineers. It draws on the published programme and the guidelines themselves. It is our reading as a dialysis parts supplier, not clinical advice.

What was KRACON 2026 about?

KRACON 2026 was held at the Pride Inn Convention Centre in Shanzu, Mombasa. The programme described the theme, "Kidney Health: Beyond Nephrology", as a deliberate provocation: nephrologists alone will not secure the future of kidney health. The five sub-themes were:

• Vision 2030 in kidney disease: are we there yet?
• Improving access to kidney health services
• Obtaining and utilising data for kidney health
• Precision nephrology: every individual matters
• The interconnected kidney: the kidney in a community of organs

The programme ran from workshops on renal pathology, peritoneal dialysis and haemodialysis to sessions on referral, fistula-first practice, peritoneal dialysis policy, green nephrology and transplant. The full KRACON 2026 programme is published by the Kenya Renal Association.

What did the new national kidney guidelines change?

The headline event was the launch, at the opening ceremony on 23 September, of The National Guidelines for the Prevention and Management of Kidney Conditions, First Edition 2026. They were developed by the Ministry of Health with the Kenya Renal Association, and the programme billed the launch as the association's first ever guideline launch.

For dialysis units, the most important section is 10.5 on maintenance haemodialysis. The guidelines describe haemodialysis as typically three sessions a week of about 4 to 5 hours, set adequacy targets of a mid-week Kt/V of at least 1.2 or a URR of at least 65% per session and state that twice-weekly schedules are generally insufficient unless there is significant residual kidney function. They also recommend synthetic polymer hollow-fibre dialyzers and set a monthly, 3-monthly and 6-monthly laboratory monitoring schedule.

We have written a separate plain-language summary: Kenya's first national kidney guidelines: what to know.

Why does the number of sessions matter for units?

Because the guidelines now put a clear standard on paper. Three sessions a week is described as typical, and twice-weekly schedules as generally insufficient for most patients. How many sessions are funded is a separate question, set by the Social Health Authority's tariffs (Legal Notice 56 of 2025, as amended). Check the current renal care access rule with SHA or your unit's claims team before planning around a number.

For units, two practical points follow:

• Measure what you deliver. The guidelines ask dialysis teams to monitor delivered dose routinely. Kt/V and URR records are the evidence base for any conversation about adequacy, with payers or with patients.
• Do not let machines erode the dose. A machine running with drifting dialysate flow or frequent alarms takes minutes away from treatment, and every session counts.

Patients should discuss their own schedule with their nephrologist. Nothing here suggests changing a prescription.

What did KRACON say about water and energy costs?

The programme included a green nephrology track on the environment and kidney disease, with a session on optimising energy consumption and water saving in haemodialysis. Utilities are a real part of what a dialysis session costs, and water treatment is also a safety issue: an unmaintained water treatment plant is a patient safety risk as well as a cost.

For engineers, the overlap with machine maintenance is direct. On machines such as the Fresenius 4008, the hydraulic circuit's heater, degassing system and balancing chamber all depend on correct inlet pressure and clean filters. A preventive maintenance cycle that checks those pressures protects both the patient and the running costs. Our Fresenius 4008 preventive maintenance guide sets out the manufacturer's checks.

What about peritoneal dialysis and access outside the big towns?

Access was a full sub-theme. The programme included sessions on home dialysis and mobile dialysis, a peritoneal dialysis policy discussion titled "Peritoneal dialysis: are we there yet? PD 1st policy" and a session on when to refer to a nephrologist. The new guidelines also include a section on maintenance peritoneal dialysis (10.6). Wider use of PD depends on reliable supplies and trained staff as well as on policy.

For the dialysis supply chain, the message is that kidney care is moving outwards to counties and closer to patients. Equipment in those settings is further from engineers and parts, which makes planned maintenance and a small local stock of critical spares more important, not less.

What should a dialysis unit do next?

Five things we would put on a unit manager's list after KRACON 2026:

• Get the guidelines in front of your team. Read section 10.5 together and compare your current schedules, monitoring and dialyzer choices against it.
• Audit your delivered dose. If you are not recording Kt/V or URR routinely, start.
• Put every machine on a maintenance calendar. Know each machine's technical safety check interval and order the TSC and maintenance kit before it is due.
• Stock the parts that stop a machine. For a Fresenius fleet, a spare complete gear pump and a few common valves on the shelf mean a failed part does not have to wait for an import. Our parts sourcing handbook covers how to plan this.
• Invest in your nurses. Much of KRACON was about skills: fistula care, PD, referral and data. Sending nurses to conferences is one of the most direct ways to build them, which is why we run our Conference Fellowship.

Nanto Med specialises in parts for the Fresenius 4008, 5008 and 6008. If your unit runs these machines and you are planning spares for the year, get in touch.

Frequently asked questions

What is KRACON?

KRACON is the annual scientific conference of the Kenya Renal Association, bringing together nephrologists, renal nurses, researchers, industry and policymakers.

When and where was KRACON 2026?

From 23 to 26 September 2026, at the Pride Inn Convention Centre in Shanzu, Mombasa.

What was the theme of KRACON 2026?

"Kidney Health: Beyond Nephrology", with five sub-themes on Vision 2030, access, data, precision nephrology and the interconnected kidney.

What guideline was launched at KRACON 2026?

The National Guidelines for the Prevention and Management of Kidney Conditions, First Edition 2026, developed by the Ministry of Health with the Kenya Renal Association.

Where can I read the KRACON 2026 programme?

The Kenya Renal Association publishes the programme on its website, kenyarenal.org, alongside the national kidney guidelines.

This article is produced by Nanto Med for educational purposes. We are equipment suppliers, not clinicians. Nothing here constitutes clinical guidance. Patients should follow the advice of their nephrologist and dialysis team.

References

• Kenya Renal Association, KRACON 2026 Annual Scientific Conference programme, 23 to 26 September 2026. https://kenyarenal.org/wp-content/uploads/2026/04/KRACON-Program-2026.pdf
• Ministry of Health, Kenya, The National Guidelines for the Prevention and Management of Kidney Conditions, First Edition 2026, sections 10.5 and 10.6. https://kenyarenal.org/wp-content/uploads/2026/10/Kenya-Renal-Guidelines-September-2026.pdf
• Kenya Law, Tariffs for Healthcare Services, 2025 (Legal Notice 56 of 2025), as amended. https://new.kenyalaw.org/akn/ke/act/ln/2025/56/eng@2026-05-08

The short answer: in September 2026 the Ministry of Health and the Kenya Renal Association launched The National Guidelines for the Prevention and Management of Kidney Conditions, First Edition 2026. They shift kidney care towards prevention and early detection, define the role of each level of care and set dialysis standards, including three haemodialysis sessions a week as typical.

These are Kenya's first national guidelines dedicated to kidney disease. They were launched at the opening ceremony of KRACON 2026 in Mombasa, and they matter to everyone from a community health promoter to a nephrologist running a dialysis unit. This post summarises what the guidelines say, in plain language, with section references so that you can read the original. We are an equipment supplier, not a clinical body: patients should discuss anything here with their nephrologist before changing anything about their care.

What are the new national kidney guidelines?

The guidelines were developed by the Ministry of Health in collaboration with the Kenya Renal Association and a multidisciplinary technical working group. According to the preface, that group included national and county governments, professional associations, training institutions, private institutions, implementing partners and patient representatives. They cover prevention, screening, diagnosis, management, referral and follow-up of kidney disease, with chapters on children, diabetes, infections, pregnancy, dialysis, nutrition and mental health.

The foreword, signed by the Director General for Health, sets out why they were needed: about 5% of deaths in Kenya are due to chronic kidney disease (CKD), and a health system focused mainly on end-stage kidney disease is "not sustainable". Earlier in the year, at the national World Kidney Day event, the Ministry put the number of Kenyans living with CKD at about 3.1 million.

Who should be screened for kidney disease?

The guidelines are clear that universal population screening is not cost-effective. Instead they recommend targeted screening of high-risk people (section 5.4), including people with:

• high blood pressure
• diabetes
• heart and blood vessel disease
• a family history of kidney disease
• a past episode of acute kidney injury
• conditions such as lupus, HIV or obesity
• high-risk jobs or exposure to substances that damage the kidneys

The screening tests named are a urine albumin-to-creatinine ratio (ACR) and an estimated glomerular filtration rate (eGFR) from a blood test. For people who remain at risk, the guidelines recommend repeat screening every 6 to 12 months. This matches the international KDIGO 2024 CKD guideline, which also uses eGFR and albuminuria together to stage CKD.

If you have high blood pressure or diabetes and have never had these two tests, that is a reasonable question to raise at your next clinic visit.

What does each level of the health system do?

One of the most practical parts of the guidelines is Table 3 (section 2.2), which assigns roles by level of care:

• Level 1, community: health promotion, early danger signs (swelling, blood in urine, less urine) and referral.
• Levels 2 and 3, dispensaries and health centres: formal risk assessment and screening, initial management of blood pressure and diabetes, referral to level 4.
• Level 4, county referral hospitals: diagnosis and staging, laboratory and imaging services, starting kidney-protective treatment, specialist consultation where available.
• Levels 5 and 6, national and teaching referral hospitals: dialysis, transplant services, sub-specialist care, training and research.

The guidelines also list indications for mandatory referral to a nephrologist (section 5.11), and they note that late referral is associated with poorer outcomes, including emergency starts to dialysis.

How many dialysis sessions a week do the guidelines recommend?

Section 10.5 covers maintenance haemodialysis. The key points:

• Haemodialysis for chronic kidney disease is typically performed three times per week, with each session lasting about 4 to 5 hours, although schedules may be individualised.
• Recommended adequacy targets are three sessions a week, 12 to 15 hours in total, and either a mid-week Kt/V of at least 1.2 per session or a urea reduction ratio (URR) of at least 65% per session.
• Twice-weekly schedules are generally insufficient unless the patient has significant remaining kidney function.
• Dialysis must be done in government-accredited centres, by a dialysis-trained nurse or technologist, following an individual prescription reviewed regularly by the nephrologist.

Patients and families should know that how many sessions are funded is set separately, through the Social Health Authority's tariffs (Legal Notice 56 of 2025, as amended). If you are unsure how many sessions you need, or how your sessions are covered, ask your nephrologist and your unit. Do not reduce or add sessions on your own.

What do the guidelines say about dialysis equipment and monitoring?

For units, three points stand out:

• Dialyzers. The guidelines recommend synthetic polymer hollow-fibre dialyzers with membranes that minimise complement and leukocyte activation (section 10.5.3). The prescription should specify efficiency, flux and size (1.0 to 2.1 m²).
• Delivered dose. The dialysis team should routinely monitor delivered dose using Kt/V or URR. A prescription only works if the machine delivers it: blood flow, dialysate flow and session time all depend on equipment that is maintained and calibrated.
• Laboratory monitoring. Section 10.5.9 sets a schedule: complete blood count, sodium, potassium, urea, creatinine, calcium, phosphate, alkaline phosphatase and albumin monthly; HIV, hepatitis B and hepatitis C serology every 3 months; parathyroid hormone, vitamin D and iron studies every 6 months.

The second point is where we work. A machine whose dialysate flow has drifted out of tolerance can quietly deliver less dialysis than prescribed. Nanto Med specialises in parts for the Fresenius 4008, 5008 and 6008, and if you run 4008 machines, our 4008 preventive maintenance guide explains the manufacturer's flow and pressure checks. We stock the genuine Fresenius TSC and maintenance kit and complete gear pump in Nairobi. For planning spares across a unit, see our parts sourcing handbook.

Where can I read the full guidelines?

The guidelines are published by the Ministry of Health, and the Kenya Renal Association hosts the full guidelines document on its website. The document states that any part may be freely reviewed, quoted, reproduced or translated with acknowledgement of the source, but not sold or used for commercial purposes.

Frequently asked questions

Are these Kenya's first kidney guidelines?

Yes. They were launched in September 2026 as the First Edition, and the KRACON 2026 programme described the launch as the Kenya Renal Association's first ever guideline launch.

Who should be tested for chronic kidney disease in Kenya?

People at high risk, including those with high blood pressure, diabetes, heart disease, a family history of kidney disease, past acute kidney injury, HIV, lupus or obesity. The tests are a urine ACR and an eGFR.

How many haemodialysis sessions a week do the guidelines recommend?

Typically three sessions a week, 4 to 5 hours each, totalling 12 to 15 hours. Your nephrologist sets your individual prescription.

What is a good Kt/V or URR?

The guidelines' targets are a mid-week Kt/V of at least 1.2 per session, or a URR of at least 65% per session. Your dialysis team interprets your results.

Should I change my dialysis schedule after reading this?

No. Discuss any questions with your nephrologist and your dialysis unit. These guidelines guide health workers; your care plan is individual.

This article is produced by Nanto Med for educational purposes. We are equipment suppliers, not clinicians. Nothing here constitutes clinical guidance. Patients should follow the advice of their nephrologist and dialysis team.

References

• Ministry of Health, Kenya, The National Guidelines for the Prevention and Management of Kidney Conditions, First Edition 2026 (foreword; preface; sections 2.2, 5.3, 5.4, 5.11 and 10.5). https://kenyarenal.org/wp-content/uploads/2026/10/Kenya-Renal-Guidelines-September-2026.pdf
• KDIGO, KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, Kidney International 2024; 105(4S): S117 to S314. https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf
• Ministry of Health, Kenya, "Government intensifies kidney disease prevention as 3.1 million Kenyans affected", March 2026. https://www.health.go.ke/government-intensifies-kidney-disease-prevention-31-million-kenyans-affected
• Kenya Renal Association, KRACON 2026 programme, Day One: "KRA 1st ever guideline launch, KRA and MOH". https://kenyarenal.org/wp-content/uploads/2026/04/KRACON-Program-2026.pdf
• Kenya Law, Tariffs for Healthcare Services, 2025 (Legal Notice 56 of 2025), as amended. https://new.kenyalaw.org/akn/ke/act/ln/2025/56/eng@2026-05-08

The short answer: the Fresenius 4008 technical manual requires a technical safety check (TSC) and maintenance every 24 months, but only if the machine meets specific rotor, software, DIP switch and titanium heater rod conditions. If any one condition is not met, the interval is every 12 months. Most hydraulic faults show up first as pressure test errors, flow drift or degassing problems.

The 4008 remains a workhorse in many Kenyan dialysis units, and much of the downtime we hear about is avoidable. Nanto Med specialises in parts for the Fresenius 4008, 5008 and 6008, so we spend a lot of time in the manufacturer's documentation. This guide sets out what the 4008 technical manual and Fresenius service training material say, so that your preventive maintenance plan is built on documentation rather than habit.

How often does a Fresenius 4008 need a technical safety check?

The manual sets two intervals. A 4008 qualifies for the 24 month interval only when all of these are true:

• each line roller pump has its own uniquely assigned rotor
• the software is within the qualifying versions (for 4008 E/B, 4.951 to below 5.00, or 5.201 and higher; for 4008 H/S, 2.951 to below 3.00, or 4.311 and higher)
• the specified DIP switch settings on boards LP 632 and LP 631 are in place
• the heater rod is made of titanium

If even one condition is not met, the TSC and maintenance must be done every 12 months. The manual also requires that each TSC is recorded in the medical device register, and that the checks are done by people qualified by training and experience to do them.

Our advice: if you cannot confirm the software version or heater rod material today, plan for 12 months. An unnecessary annual check costs a kit. A missed one can cost the machine.

What does 4008 preventive maintenance replace?

The preventive maintenance (MA) items in chapter 2 of the manual are the parts that wear quietly. They include:

• the seals in the concentrate and bicarbonate suction tubes (lubricated with silicone paste on refitting)
• the suction tube filters
• the check valve, plus the check valves and filters on central delivery (CDS) machines
• the filter sieves upstream of the UF pump, downstream of valve 43 and on the rinse chamber lines
• the filter sieve in the dialyzer line
• the O-rings in the dialyzer couplings
• the belt ribbon and line segment of the air separation pump
• the fan filter in the monitor (clean or replace)
• valve 84 after 2 years, where Puristeril is used for disinfection
• filter 210, where fitted
• any worn or dirty tubing

Options such as DIASAFE filters, bibag connectors or online HDF add their own items, so work from the checklist for your machine's configuration.

Fresenius supplies a TSC and maintenance kit for the 4008 (part M339331). We stock the genuine Fresenius TSC and maintenance kit for the 4008 in Nairobi. Check the kit contents against the MA checklist for your configuration, and order before the due date, not after: a TSC that waits for parts is a TSC that gets skipped.

What are the signs of a failing flow pump?

The 4008 hydraulic circuit relies on two pumps that matter most here: the flow pump, which pushes dialysate into the balancing chamber, and the degassing pump, which pulls dialysate through a restriction to strip out dissolved air. The manual's theory of operation explains that the balancing chamber valves are reversed by the current rise pulses of the flow pump's drive motor, so a tired flow pump does not just reduce flow. It can disturb balancing.

Watch for:

• Dialysate flow out of tolerance. The TSC check collects fluid at the drain. At a set flow of 800 ml/min the acceptable range is 765 to 837 ml/min; at 500 ml/min it is 471 to 528; at 300 ml/min it is 279 to 321.
• Flow pump pressure you cannot bring back into range. Measured at port C with 800 ml/min selected, the rated value depends on the loading pressure (for example 2.2 bar ± 0.05 where loading pressure is 1.45 bar). If adjusting relief valve 78 will not bring it back, suspect the pump.
• Balancing chamber switching errors during tests or treatment.

When a pump is worn, replacement is usually faster than repair. We stock the genuine Fresenius complete gear pump (part 6751421), used in the 4008 hydraulic circuit and also listed for the 5008 and 6008. Confirm the part number against your machine's spare parts list before ordering.

How do you know a solenoid valve is leaking?

The balancing chamber works with eight solenoid valves (31 to 38). If any of them does not seal, the machine cannot balance fresh and spent dialysate accurately, and ultrafiltration accuracy suffers. The 4008 runs pressure holding tests to catch this, and the manual's error descriptions point straight at valves:

• Negative pressure holding test failure (F06): the dialysate pressure drop exceeds 40 mmHg over ten balancing chamber switchings, which the manual attributes to a leak in the hydraulic system.
• Positive pressure holding test failures: the manual names specific valves as causes, for example V26 leaking, V24B not closing, V24 or V24B not opening, or the balancing chamber valve V36 or V38 leaking.

The Fresenius training material describes a bench test for each balancing chamber valve: create about minus 500 mmHg, watch the pressure for 3 minutes and accept a change of no more than 40 mmHg. A valve that fails that test is a valve to replace.

We stock genuine Fresenius high Kv solenoid valves for the 4008: the one-port high Kv valve (M339901) and the two-port high Kv valve (M339911). The 4008 uses several valve types in different positions, so match the part number to your machine's spare parts list.

How can you tell the degassing drive is failing?

The degassing pump pulls dialysate through a degassing orifice and creates a negative pressure of about 0.8 bar. The manual's rated value at port D is minus 0.81 to minus 0.85 bar. Poor degassing leaves air in the dialysate, and the manual is direct about the consequence: air bubbles in the balancing chamber cause balancing errors.

Signs include:

• degassing pressure that drifts out of range or will not hold after adjustment
• the manual's "V39 failure" message, where one listed cause is that the degassing pump cannot be re-adjusted
• rinse failures during disinfection programmes

Before you replace the drive, check the cheap part first. The manual lists a clogged filter upstream of the degassing pump (filter 210, or the cartridge filter) as a cause of the same errors. A clogged or wrong filter can make a healthy drive look faulty. If the drive itself has failed, we also hold the genuine Fresenius degassing pump drive for the 4008 (part 6707671).

What should a 4008 preventive maintenance plan include?

A workable plan has four parts:

• A due date per machine. Record each machine's interval (12 or 24 months) and the reason, in the device register.
• A pressure baseline. At every TSC, record water inlet pressure (0.9 to 1.4 bar), loading pressure, degassing pressure and relief pressure. A slow drift between visits is your earliest warning.
• Volumetric checks. UF pump: 60 strokes should deliver 60 ml (± 0.5 ml). Balancing chamber: the average volume per switching should be 30 ml (± 1 ml). Temperature at the dialyzer couplings: 37 °C (± 0.5 °C). Conductivity must agree with a reference meter.
• Parts on the shelf. One maintenance kit per machine due in the next quarter, and for a larger fleet, a spare pump and a few common valves. Our parts sourcing handbook explains how to plan this without tying up cash.

One point the manual makes plainly: assembly, adjustments and repairs may only be carried out by the manufacturer or persons it authorises, with the right test equipment. Use this guide to plan and to ask better questions, not as a substitute for trained service.

Frequently asked questions

How often should a Fresenius 4008 be serviced?

Every 24 months if it meets all the manual's conditions (rotor assignment, software version, DIP switch settings and a titanium heater rod), otherwise every 12 months.

What is a TSC on a dialysis machine?

A technical safety check: a documented set of visual, electrical, hydraulic and functional checks defined by the manufacturer, recorded in the medical device register.

What is the normal degassing pressure on a 4008?

The manual gives minus 0.81 to minus 0.85 bar, measured at port D on the suction side of the degassing pump.

Why does my 4008 fail the pressure holding test?

The manual links the negative pressure holding test failure to a leak in the hydraulic system. Leaking balancing chamber valves and worn seals are common causes. Each balancing chamber valve can be tested individually.

Are the 4008 parts Nanto Med stocks genuine?

Yes. The gear pump, TSC and maintenance kit, degassing pump drive and high Kv solenoid valves we stock for the 4008 are genuine Fresenius parts, made in Germany.

Can I replace a gear pump myself?

Only if you are trained and authorised to service the 4008 and have the test equipment to recheck pressures and flows afterwards.

This article is produced by Nanto Med for educational purposes. We are equipment suppliers, not clinicians, and this is not a substitute for the manufacturer's service documentation or authorised service. Fresenius and 4008 are trademarks of Fresenius Medical Care. Nanto Med is an independent supplier and is not affiliated with Fresenius Medical Care. The 4008 parts linked in this article are genuine Fresenius parts.

References

• Fresenius Medical Care, 4008 E / 4008 B / 4008 H / 4008 S Hemodialysis System Technical Manual, edition 5/03.09, chapter 2 (technical safety checks and maintenance) and chapter 1 (theory of operation and error descriptions).
• Fresenius Medical Care, 4008 Dialysis Machine Training, Diagnostics and Applications section, May 2001.