ADEZE OJUKWU
The gravity of kidney disease and its colossal financial demands, can be described as a revolving nightmare, particularly in Nigeria with scant attention to public health.
Amidst the horrendous battle for survival and desperate cries for help, most sufferers reel with anxiety and anguish, as the debilitating disease gulps their health, strength and wealth.
About 20 percent of Nigerians are reportedly affected by kidney-related ailments, hence requiring urgent government response with special funding for renal treatment and research.
As Nigeria marks this year’s World Kidney Day (WKD) today, Federal Government should review its policies to ameliorate the plight of patients, especially children, women, the aged and those in dire need of dialysis and transplants.
The global and national burden of Chronic Kidney Disease (CKD) is huge and a major health concern, due to high mortality rates. ‘CKD affects approximately 195 million women worldwide and it is currently the eight leading cause of death in women, with close to 600,000 deaths each year.’ Apex global coalition on kidney health, the International Federation of Kidney Foundations (IFKF) said it is higher in low income countries as Nigeria.
With special focus on women, this year’s programme is unique as it is jointly marked with International Women’s Day(IWD) 2018.
The collaboration provides a special opportunity to reflect on the importance of women’s health and specifically their kidney health. The group, which leads the campaign for prevention and treatment of kidney disease with 60 organisational members across over 40 countries, said this year’s edition is promoting access to affordable and equitable healthcare and prevention of kidney diseases for all women and girls in the world.’ With the theme “Women and Kidney Disease, the body along with International Society of Nephrology (ISN) and other health agencies are galvanizing global resources to decimate the disease.
Dr Abdulwasiu Busari, Consultant Nephrologist, Gbagada General Hospital lamented the high rate of the disease saying this year’s focus on women was apt, due to gender related complexities. ‘Pregnancy makes women vulnerable to kidney disease, because of complications such as Pregnancy Induced Hypertension (PIH) and eclampsia. Prevalence of autoimmune disease including lupus nephropathy and chronic kidney infections are also major causes of End Stage Renal Disease(ESRD).’
‘Nephrology Units of Gbagada General Hospital and Lagos State University Teaching Hospital (LASUTH) have organized activities such as awareness campaign walk, health talk and medical screening for risk factors of kidney disease among women,’ Dr Busari added.
A consultant nephrologist at Lagos State University Teaching Hospital(LASUTH), Dr Theophilus Umeizudike confirmed IFKF position that ‘the risk of developing CKD is as high in women as in men.’ According to him, some studies show that CKD is more likely to develop in women compared with men, with an average 14 percent prevalence in women and 12 percent in men.
Sadly the number of women on dialysis is lower than the number of men, even in Nigeria. ‘CKD progression is slower in women compared to men, psycho-socio-economic barriers such as lower disease awareness lead to late dialysis among women and uneven access to care is a major issue in many countries. Kidney transplantation is also unequally spread, mostly due to social, cultural and psychological factors. Women tend more often to donate kidneys and are less likely to receive them.’ Policy makers, according to experts, must address these inequities and discriminatory practices against women folk. In Nigeria, a CKD patient requires about N150,000 weekly for three sessions dialysis.
Those who are fortunate enough to get a willing donor will require about N10 million to get kidney transplants in India, at least. The post transplant drugs and routine tests revolve around N3 million yearly. How many ordinary citizens can afford these humongous expenses?
Sadly, government seems nonchalant about the plight of the citizens. Successive governments have failed in their responsibilities to mitigate the suffering of patients of kidney diseases, as well as cancer, diabetes, hypertension among others.
The parlous state of the nation’s tertiary health facilities including Aso Rock Clinic, is a reflection of government’s lack-lustre commitment to the health of the citizenry. It requires no rocket science to aver that the nation’s decrepit health sector impacts adversely on the economy and productivity.
How can a country thrive with an unhealthy and impoverished population? What a shame that the current administration promised to stop medical tourism, yet its executives and their cronies patronize top flight hospitals abroad, at the expense of tax payers.
Majority of citizens, according to development indices, are impoverished. Federal Government must find the goodwill to support treatment of ESKF, as the kidney function falls to critical levels with life-threatening complications and prohibitive cost of surgery, regular dialysis or home- based peritoneal dialysis.
Sadly peritoneal option for adults is not readily accessible in the country according to Dr Umeizudike.
‘It is not routinely done in adults in Nigeria, due to high infection rates and cost of importing the materials, however some teaching hospitals offer peritoneal dialysis to children,’ he explained
Belgian nephrologists, Dr David W. Johnson and Dr Isaac Teitelbaum urged developing countries to embrace this alternative because of its positive outcomes on patients, costs and burden on care givers. ‘Vast majority of countries trying to address the burgeoning problem of ESKF have done so by establishing haemodialysis units, which use artificial kidneys to filter patients’ blood, typically based in hospitals and healthcare facilities, and are both labour- and cost-intensive. However, in resource-poor countries with limited human, financial resources and geographic barriers, it is generally more appropriate to opt for peritoneal dialysis, where dialysis fluid is instilled by a catheter into the abdomen and changed regularly. This home-based form of dialysis treatment costs less, gives greater patient independence, greater treatment simplicity, excellent patient outcomes, decreased need for electricity and technical support, reduced need for trained medical staff, greater feasibility for remotely living patients, and easier management in the setting of natural disasters.
Ojukwu, a journalist, writes via [email protected]
‘As a result, several key countries, including China, Hong Kong, Thailand, the Philippines and the USA, have enacted public healthcare policies that promote and financially aid the use of peritoneal dialysis over haemodialysis,’ they noted.
It would be good if the Federal Government would consider this option as well as the comprehensive document submitted to the presidency two years ago by Nigerian nephrologists, as part of a national response strategy on renal disease.
In Israel, America, Britain, India, Tanzania, Ivory Coast and other African countries renal care is free or subsidized substantially.
Nigeria should do same and save its citizens from unwarranted sufferings.
It is delightful that Israel, America and few others are leading global research and investments in stem cell technologies, which essentially hold the ace for regeneration of distressed kidneys and other organs.
Ojukwu, a journalist, writes via [email protected]