Thanks to dialysis, more people with chronic kidney disease are living longer today. It is estimated that despite the increased risk of mortality, patients with chronic kidney disease can have an extended life expectancy with dialysis care and treatment.
Recently, the President of the Nigerian Association of Nephrology (NAN), Ifeoma Ulasi, said that 25 million Nigerians have kidney disease. As a result of this new finding, the NAN’s president also called for more attention to this life-threatening condition and the effective treatment in health systems.
These calls are timely and important as the world celebrates World Kidney Day on March 12.
The Annual World Kidney Day is an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. Commemorating the day each year is intended to emphasise kidney health and raise awareness on kidney disease worldwide. The theme for 2020 is – ‘Kidney Health for Everyone Everywhere’.
Why are 20 million Nigerians at risk?
Kidney disease refers to the injury or damage to the kidneys that has usually been on for a long time.
Chronic kidney disease or CKD is a progressive condition that reduces kidney function (basically its ability to filter waste from the blood). Chronic kidney disease often has no symptoms in its early stages and can easily go undetected in most people until it is in its advanced stages.
In this late or advanced stage of CKD, an individual can develop kidney failure and require dialysis or a kidney transplant to maintain life. At this stage, a CKD patient is said to lose 85-90 per cent of their kidney function; not enough to keep the person alive, without medical intervention.
This is also known as end-stage kidney disease (ESKD), or end-stage renal disease (ESRD). Without the kidneys playing their vital role, substances that should otherwise be filtered, build up in the body. This makes the person severely ill. This is also when symptoms become glaring.
People notice symptoms such as frequent or infrequent urination; shortness of breath, swelling in feet and ankles, muscle cramps, nausea and vomiting. Once any of the symptoms have been observed, there is a need for dialysis or kidney transplant to live. A doctor will usually decide which is necessary, depending on the disease stage.
The idea behind dialysis is that the process of filtering waste and extra fluid in the blood would replace the functions of the kidney. A typical dialysis session will be required at least two or three times a week for 3-5 hours at a designated dialysis centre.
Dialysis is, simply put, a medical procedure instituted by a Nephrologist as a treatment to temporarily or sometimes permanently take over the function of the kidney by removing waste products, toxins, or excess electrolytes from the blood, as well as removing excess water. There are two types: Haemodialysis (more commonly done) and Peritoneal dialysis.
In Nigeria, the leading causes of kidney disease are – high blood pressure, diabetes and glomerulonephritis (kidney inflammation from a variety of causes). In 2019’s World Kidney Day celebrations in Nigeria, an alarm about two new leading causes of kidney diseases for Nigerians was raised. These were identified as toxicity caused by long term drinking of traditional herbal concoctions and exposure to harmful chemicals due to long term use of skin whitening creams.
In Nigeria, other causes of kidney disease include high cholesterol, kidney infections, kidney stones, polycystic kidney disease. In addition, environmental pollution, unsafe drinking water, abuse of analgesics and use of pesticides have also been linked to the development of kidney disease. It is also worth noting that there are certain high-risk groups. Older people, individuals who smoke and are obese have a greater likelihood of developing CKD.
A Nephrologist’s viewpoint
Moses Tari, a Nephrologist at the Federal Medical Centre, Birnin Kebbi, said kidney disease makes up a large part of daily hospital admissions in Nigeria.
“It affects all ages and genders and commonly complicates diabetes, and hypertension. Most patients present late, requiring life saving interventions and procedures.”
He noted further that “chronic kidney disease constitutes about 40 per cent of referrals to tertiary hospitals. It is an almost constant scenario after reviewing the daily admissions of most tertiary hospitals.”
For Mr Tari, “most cases of CKD present when the kidney function cannot sustain normal life and the patients require emergency dialysis to stay alive”.
Dying for Dialysis
With the cost of dialysis sessions ranging from N20,000.00 to N50,000.00 per session. It is worth noting that the global standard recommendation for dialysis is a number of 3 sessions a week for an average of 3-5 hours.
However, a study labelled the rate of adherence a “fry cry from the recommended standard” in Nigeria.
On account of the cost, a person suffering from kidney failure reportedly opts for fewer dialysis sessions; sometimes even once a week. Another study in Nigeria noted that none of the 101 participants in the Ekiti University Teaching Hospital’s dialysis centre could maintain three sessions per week for three months.
The discontinuation of dialysis is frequently reported in Nigeria and has serious health implications on those suffering from Kidney failure.
Also, with few Nigerian tertiary health facilities having functional dialysis treatment centres, the prognosis for CKD patients in Nigeria seems all too bleak. Not surprisingly, most CKD patients in Nigeria travel long distances from state to state, searching for cheaper dialysis centres with functioning units. In some states, tertiary facilities often have no dialysis machines.
All of this is further exacerbated by the fact that the alternative to dialysis which is transplantation is not one many can turn too either. The cost of a kidney transplant is indeed over N6,500,000.00.
Call to action
Despite years of advocacy actions by the Nephrology Association of Nigeria and other pressure groups, the National Health Insurance Scheme (NHIS) in Nigeria currently only provides limited coverage for CKD patients.
There is increased and coordinated advocacy from nephrologists, cardiologists, haematologists to the government at national and state level to expand coverage for CKD patients as part of new efforts to bring the National Health Insurance under one roof.
Moreover, the government must do more to educate the public on kidney disease prevention. There is little information to educate the general public on how to protect their health and prevent disease. More must be done in this important area of health promotion.
Most young ladies striving for a beautiful complexion are not aware that bleaching creams can cost them their kidneys and most patients managing diabetes type 2 are unaware that kidney disease can be a complication. Health promotion is thus central to address this gap in knowledge.
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Nigeria also needs more dialysis nurses and more specialised technicians to repair machines that are prone to breakdowns due to frequent power fluctuations and interruptions.
Infection prevention training and protocol supportive supervision is imperative as HIV and Hepatitis patients are also affected by CKD and also access dialysis treatment in Nigerian facilities.
So, as we celebrate World Kidney Day 2020, we must also take action.
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