Daily Trust (Abuja)

Nigeria: Tackling Challenges Facing Kidney Failure Patients

Last year, the Nathan Kidney Foundation reported that 15,000 new cases of end-stage kidney failure emerge annually in the country.

The foundation says that this development can be attributed to the increase in the number of Nigerians living with hypertension, diabetes, obesity and glomerulonephritis -- a kidney disease.

Mr Banke Ajomale, the foundation's Executive Director, says that kidney diseases develop slowly and often show symptoms at later stages.

It is, therefore, not surprising that kidney and urinary tract diseases are ranked 12th in the list of major causes of death in the world by the World Health Organisation (WHO).

Ajomale says that without warning signs, kidney failure could have reached an advanced stage before the victim knows that something is wrong.

He describes such situations as unfortunate because once a person's kidneys are damaged; they are left with the limited options of dialysis or renal replacement therapy to live.

He says that dialysis is the process of repeatedly using a blood-cleansing machine to perform kidney functions, while the renal replacement, also known as kidney replacement, involves getting a kidney transplant.

"Unfortunately too, most Nigerians cannot afford a renal transplant or to pay indefinitely for dialysis.

"Presently, dialysis costs about N5 million annually, while a kidney transplant costs about N4 million and a patient needs about N150, 000 monthly to get immunosuppressive drugs after a successful transplant.

"In essence, kidney failure is usually a death sentence if not detected early and managed appropriately," Ajomale says.

Faced with such grim situations, what then is the hope of survival for people suffering from kidney failure?

Prof. Oladipo Akinkugbe, the first President of the National Association of Nephrology, gives an insight into what could be a respite.

He stresses that prevention is the major solution to kidney failure problems, stressing that the association, since its inception, has focused its attention on the last stage of kidney disease.

He says that the association's focus will later be on prevention.

"What is important is to see the things that cause chronic kidney disease and prevent them in our environment," he says.

Corroborating this viewpoint, Dr Oluseyi Oniyangi, the Head of Paediatrics at the National Hospital Abuja, says that eating good food, undertaking physical exercises regularly and going for regular medical checkups help in sustaining healthy kidneys.

She stresses that kidneys play essential regulatory roles in keeping the body in good shape, adding, therefore, that they should always be kept healthy.

Oniyangi expatiates that kidneys are essential for the removal of waste from the body, regulation of blood pressure, balancing of sodium and potassium and production of hormones that help build red blood cells and bones.

She, however, notes that some risk factors of chronic kidney diseases include congenital dysfunction, hypertension, diabetes, sickle cell anemia, alcohol, HIV and certain drugs.

She stresses the need for people to take adequate precautions to curb kidney failures.

"Make sure you change your underwear daily, clean up properly, wash your hands after using the toilet and drink plenty of water to keep the kidneys healthy.

"Besides, avoid intake of too much salt, make sure you go to the hospital early when you are sick, complete your medication and avoid indiscriminate consumption of pain killers.

"People should also avoid bleaching creams and soaps, while hypertensive and diabetic patients should endeavour to take their prescribed medication," he further warns.

All the same, Dr Raheem Raji, Senior Registrar, Nephrology Unit, Lagos University Teaching Hospital, examines the major causes of kidney diseases.

He says that the causes include diabetes, hypertension and kidney infections that are common among people who live in small communities and shun regular medical checkup.

Raji also says that the ingestion of certain herbal medication could, over time, affect the kidney.

"The problem of lack of awareness about kidney disease ought to be addressed, as these people do not know they have the disease until the situation degenerates before coming to the hospital," he says.

He emphasises that the government has a huge role to play in efforts to create the much-needed public awareness.

Raji said that the disease is one of the major public health concerns in Nigeria, as the level of morbidity is very high; adding that proper awareness at the grassroots will, however, reduce the disease burden.

However, Prof. Evelyn Unuigbe, the President of the Nigerian Association of Nephrology, underscores the need to establish a national kidney institute in the country.

She says that the institute would address issues relating to all types of renal care, while stemming the current wave of medical tourism to foreign countries for the treatment of kidney diseases.

Unuigbe, however, notes that facilities for kidney failure treatment in the country have improved in the past 25 years to such levels that more than 60 centres are now able to provide renal replacement therapy.

She observes that seven government hospitals and a private hospital also have kidney transplant capability.

"Unfortunately, such facilities are sparsely located and the rest are ill-equipped to offer optimal services to patients, compelling a good number of the patients to seek help in countries like India, South Africa, Britain and U.S.

"Nigeria has a lot of qualified doctors who could handle serious kidney and heart-related diseases if they are properly supported by the government," she says.

Besides, Unuigbe calls for a national renal care policy, saying that it will standardise the practice of kidney care and stipulate government's subsidy for kidney care.

According to her, the U.S, Saudi Arabia, Egypt, and Tunisia are able to treat renal diseases because their governments funded renal care.

She says that small-scale community studies and hospital-based studies carried out by members of the association have given some insight into the epidemiology of kidney diseases in Nigeria.

Unuigbe says that result from the studies of chronic kidney disease, carried out on adults in small communities, reveal that about 19 to 30 per cent of the sampled group have kidney problems.

"The situation is so grave in Nigeria where we have found that kidney diseases accounted for six to 12 per cent of medical admissions and it affected young people between the ages of 25 to 40 years.

"This is an age where the people are expected to be economically productive and contribute to national development.

"Sadly, the disease is largely unrecognised and inadequately diagnosed; hence, the emphasis on prevention and detection of the early stages of the disease," she says.

Unuigbe stresses that the situation is particularly bleak for small children who need dialysis, even as the Minister of Health, Professor Onyebuchi Chukwu concedes that the cost of kidney treatment remains a major challenge.

Nevertheless, Dr Chinwuba Ijoma, the immediate-past President of the Nigerian Association of Nephrology, says that the establishment of a national renal institute will be quite helpful.

"The national renal institute is supposed to be a well-established, well-funded and well-administered institute that would quality provide clinical services for patients.

"It should also provide training for all cadres of personnel; the nephrologists, surgeons, nurses and technicians.

"It should as well conduct research, particularly in areas relevant to the management of kidney disease in our environment.

"The institute is also supposed to be a referral centre and we expect that people from even outside Nigeria can come there to acquire training in the management of kidney disease.

"The National Association of Nephrology had articulated a comprehensive renal care policy, which we has been submitted to the Federal Ministry of Health," he says.

Ijoma stresses that that the association has been calling for the establishment of the centre for over a decade, adding that changes in the federal administration are, however, responsible for the delay.

"Each time there is a change of administration, it appears that we have to almost start afresh to discuss issues again," he says.

Concerned health experts, therefore, urge the authorities to hasten action on the establishment of the institute so as to assuage the sufferings of kidney failure patients.

NANFeatures

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