Kidney Disease: Late detection, high cost hinder treatment for affected Nigerians

After undergoing dialysis on Thursday at the Garki general hospital in Abuja, Dannuma Tadi, a retired army officer, said he was already thinking of where to get money for the next one.

The cost of each dialysis session is N23,000 at the hospital and Mr Tadi needs at least two treatments each week to keep his system filtered and running.

Mr Tadi, 64, has been battling high blood pressure and diabetes for nearly 30 years. Two years ago, he was diagnosed with end-stage (stage 5) kidney disease.

The stages of kidney disease are based on how well the kidneys can filter waste and extra fluid out of the blood. At Stage 5, the kidneys are working at less than 15 per cent capacity or the person has kidney failure. When that happens, the buildup of waste and toxins becomes life-threatening.

Dialysis serves as the only lifeline for people like Mr Tadi at this stage. It is the most common treatment for severe kidney failure. If you have permanent kidney damage, you could need dialysis for the rest of your life if you cannot afford a kidney transplant.

Kidneys filter wastes and excess fluids from the blood which are then excreted in the urine. When someone has chronic kidney disease, their kidneys are unable to perform these tasks and they require renal replacement therapy in the form of dialysis or kidney replacement.

 Early detection

For many years, doctors were busy treating Mr Tadi for high blood pressure and diabetes without recommending a kidney test for him. This allowed his kidney disease to get to an advanced stage, he said.

The tricky thing is that the three diseases have similar symptoms and could be mistaken for each other, according to Frank Aboh, a nephrologist or kidney specialist.

“The other hospitals I was going to did not test me for kidney disease until I came to Garki hospital where I was diagnosed of stage 5 kidney disease and that was the beginning of the end of another battle,” Mr Tadi, a retired lieutenant colonel, said.

If kidney disease is detected early, it can be managed and corrected but at the end-stage, the patient is said to have lost 85-90 per cent of his/her kidney function; not enough to keep the person alive, without medical intervention such as dialysis or a transplant.

Dialysis

Mr Tadi said he has been living on dialysis in the past 22 months since he cannot afford a kidney transplant.

Dialysis is 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.

A typical dialysis session will be required at least two or three times a week for 3-5 hours at a designated dialysis centre.

After Mr Tadi’s Thursday session which coincided with the World Kidney Day, the sexagenarian said his pocket has run dry and he does not know where to get money for the next section.

“Honestly my pocket could not sustain this treatment. My family, friends, and some support groups have been helpful but I don’t know how long this help can be sustained.

“I do two sessions every week which is N46,000, for almost two years, and whenever there’s a delay in going for a session due to lack of funds, I get severely sick,” he said.

Surviving Kidney disease in Nigeria

Many patients suffering from kidney disease, like Mr Tadi, undergo similar ordeals in Nigeria.

They often foot the huge costs of treatment out-of-pocket as the National Health Insurance Scheme (NHIS) only covers a fraction, which is insignificant when treating kidney complications.

The President of the Nigerian Association of Nephrology (NAN), Ifeoma Ulasi, said 25 million Nigerians have kidney disease, and more than half of the potentially eligible patients are turned down for dialysis as a result of cost.

Apart from dialysis being costly, there are too few facilities that can perform a full and effective transplant in Nigeria prompting many patients to seek services overseas at an even higher cost.

World Kidney Day

World Kidney Day is observed on the second Thursday of March each year with the primary objective of spreading awareness around the globe on the need for identifying kidney disease as a significant public health problem.

The theme for World Kidney Day 2021, ‘Living Well with Kidney Disease,’ motivated the management of the Garki hospital in Abuja to organise outreach for patients.

As early as 9:00 a.m. on Thursday, a canopy was already set up at the back of the dialysis unit of the hospital as patients trooped in to receive various free medical routines by the hospital.

Some of the free medical routines include: a kidney health talk; blood pressure check; diabetes screening; kidney check or urinalysis; body mass index assessment; and medical consultation.

“Over the years, the emphasis has been on prevention of kidney diseases but this year the theme is focusing on people already living with the disease and that was what spurred this outreach”, Benjamin Oyime, a consultant physician and nephrologist who coordinated the event, said.

“We want to ensure these patients are getting the right medical attention. They already face physical challenges such as fatigue, lack of appetite, and psychological challenges such as depression, low self-esteem and anxiety. Some of them have lost hope due to the huge medical costs.

“This year, we are trying to address these challenges the patients are facing while battling the disease. That’s what theme year is all about.

“We also want to ensure that people test and detect the problem early and that is why we want people to know their numbers which means: blood pressure, sugar level weight, height, and cholesterol level as well as how much protein is coming out of the body because once you are excreting a lot of protein your kidney is at risk,” he explained.

Regular screening in high-risk group population helps in the early identification of the disease.

The medical doctor also decried poor funding for kidney disease intervention in Nigeria.

“The truth is that when you go to developed countries, kidney treatment: dialysis, and even transplant are all free,” he said.

“But in Nigeria, most patients have to battle the cost on their own and a majority can’t afford the treatment. Many patients who cannot afford to come for dialysis twice a week resort to doing it once a month which is very dangerous for their systems.”

He urged the government to create an intervention that will make routine dialysis totally free.