Tag: kidney failure

Kidney failure is a major health issue in Nigeria. OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU writes that though the risk is higher with ageing, it can be prevented.

As the country marked the World Kidney Day last Friday, Nigerians have been called upon to go for routine medical checks for diabetes and high blood pressure to prevent kidney diseases.

This year’s theme was: “Chronic kidney disease and ageing.”

Chronic kidney disease (CKD) is the progressive loss of kidney function over months or years. In its early stages, the disease produces no symptoms and is treatable. But in more advanced stages, patients can require dialysis and kidney transplants.

According to an interventional nephrologist, Dr Emmanuel C. Anekwe, kidneys can be affected or damaged by various diseases, but early detection would go a long way in preventing chronic damage as a result of diabetes mellitus.

“Age increases the risk of problems with the kidney, such as inflammation or swelling of the kidneys, diabetes mellitus, urinary tract infections, urinary incontinence and renovascular disease. Kidney problems can also increase the risk of other conditions such as cardiovascular disease. Early detection and good management can increase the life of your kidneys,” Dr Anekwe said.

He continued: “Generally, the biggest reason why kidney diseases are on the increase in Nigeria is because most people are being more western lifestyle. And with it comes the cost, especially diet, which leads to Diabetes mellitus. The preponderance of kidney diseases in Nigeria is exponentially high.”

He noted that diabetes, high blood pressure and ageing are the main risk factors for developing chronic kidney disease.

A World Health Organisation (WHO) Advisor on prevention and control of non-communicable diseases, Pedro Orduñez, also noted that: “Being physically active, not smoking, having a healthy diet that’s low in salt and sugar, and getting blood pressure checked regularly can prevent hypertension and type II diabetes. And if one has diabetes or hypertension, keeping those under control can prevent them from damaging the kidneys.”

Anekwe while identifying other risk factors for kidney disease said: “Some conditions that affect the kidneys and urinary tract are more common as people get older. A person is more at risk of developing kidney disease if over 60 years of age; have diabetes; is obese; have high blood pressure; have established heart problems (heart failure or past heart attack) or have had a stroke; or if he is a smoker; have a family history of kidney disease or of Aboriginal.”

He said to detect CKD, experts recommend blood and urine tests, and blood pressure checks, especially in high-risk groups including people with diabetes or hypertension, those over 65, people who have suffered a heart attack, those with relatives who have had kidney disease, smokers, and sedentary people.

“Simple, low-cost treatments that can slow the progress of kidney disease and reduce the risks of heart attack and stroke while improving quality of life are available,” said Anekwe.

Meanwhile, a Consultant physician/nephrologist at St Nicholas‘ Hospital, Lagos, Dr Ebun Bamgboye said there is the need to raise awareness on early detection.

He said the ailment is a common problem in Nigeria.

Dr Bamgboye said: “It is recommended that kidney screening should be done yearly.The individual in the early stage of CKD tends to pass out urine more frequently. He may visit the toilet three or four times at night. After that the urine volume starts to decrease. Then the urine starts to foam. This is due to a lot of protein in it. And it is one of the earliest signs of damaged kidney. Then the face and feet start to swell. The individual can have loss of appetite, nausea and hypertension.”

Some of the reasons, according to Bamgboye, are because the country has an aging population and the rampant nature of the conditions causing the ailment.

He identified diabetes as the most common cause of CKD, adding that hypertension, which is estimated at 35 per cent in the country and chronic infections are other causes among Nigerians.

He said Hepatitis is another major cause. About 15 per cent of Nigerians, he said, are affected by hepatitis B.

Bamgboye, President, Nigerian Association of Nephrology (NAN), said though there was no national data on CKD, about 16,000 Nigerians, representing less than one per cent of the estimated 167 million population, could be suffering from CKD.

“This figure will end up requiring renal replacement therapy, which can be dialysis or a transplant,” he added.

He said, according to NAN’s statistics, there are 74 registered dialysis centres across the country.

About 2,000 patients according to Bamgboye access dialysis at the centres, adding that the shortfall was huge.

This, he said, was not good for kidney patients who are at the end stage because they could die if they do not get dialysed.

“Many died because they didn’t get prompt diagnoses or didn’t have access to a place where dialysis can be done,” he said.

He urged the Federal Government to fund the treatment of end stage renal disease (ESRD) as obtained in developed countries.

“The United States spends about $42 billion yearly on renal care. Of this, $20 billion is spent on dialysis and transplantation. Nigeria should be able to provide some funds for ESRD,” he noted.

He said government could provide 20 centres where kidney screening can be carried out by NAN members.

“Prevention due to early screening and detection should be the focus. The predisposing factors such as hypertension and diabetes should be prevented.Governments in many countries across the world are subsidising the cost of dialysis, Nigeria should not lag behind.

“NAN has looked at various measures that can help to reduce the charges. We want to explore the possibility of manufacturing locally, some of the drugs. I know the National Health Insurance Scheme (NHIS) now supports certain number of sections of dialysis. I think the section is six, but NAN is trying to see if it can be extended by three,” he stated.

Dr Bamgboye said “the association is concerned about some dialysis centres in the country which are not appropriately staffed and supervised. Dialysis is invasive, so patients can get infected and also lose blood.”

Last Christmas, 50-year-old Peter Olayiwola was hale and hearty. With pomp, he joined friends and relations in the yearly celebration of the birth of Jesus Christ.

Then came the midnight of December 31, 2013, when he hit the church to seek for himself a happy New Year.

Indeed, he enjoyed blissful moments for four weeks at his 30, Igbehinadun Street, Shasha, Lagos home, where he is a strong member of the Olaoluwa Community Development Association (CDA). Nothing gave his aged mother, a petty trader, any inkling that her joy over him would soon take a tumble.

However, since 2011, Peter had battled hypertension, which the family had managed well with medical attention until February 6 when he was diagnosed with failure of both kidneys. He has since been receiving medical treatment at the Alimosho General Hospital, Igando.

Peter was in tears as he spoke with this reporter: “I am suffering from back pain, swelling, dizziness, cold, skin itching, short breath and inability to concentrate which makes me lose my hope of living.” The ailment, he added, had deprived him of his bounden responsibility as a father.

Following the recommendation of a medical expert, he started undergoing dialysis to mitigate his troubles. But the doctor advised that Peter would need to undergo a kidney transplant to live a stable life.

After researches by his parents, it was agreed that he should be taken to India for the surgery which will cost a whopping N8 million.

His helpless parents said they had exhausted their savings and sold all they could lay their hands on to make him live. Hence, they sought urgent financial support from the public, the government and private organisations to rescue Peter.

They have, therefore, opened an account, Peter Olayiwola at the Sky Bank with No: 1040458159 or GTBank Acct/No.0016623876 under the name: Peter Olayiwola, for the attention of his prospective helpers.

Kidney failure is becoming a major health issue in Nigeria. OYEYEMI GBENGA-MUSTAPHA writes on how Dr Emmanuel C. Anekwe, an interventional nephrologist, is standardising dialysis and kidney diseases care.

Ibraheem Gafar (not real name), a 47-year old banker with end stage renal failure, is full of praises for Kidney Solutions Limited (KSL) – a dialysis outfit. The centre is barely a month old but its reputation is spreading fast among experts, patients and stakeholders in renal care.

Clients and experts in kidney care say the firm has a human face and is highly professional in its services. Gafar, who is awaiting kidney transplant, had been to some dialysis centres and noticed how clients were treated. He said the centres’ focus was on money; their handling of other issues is poor. Before he undergoes transplant, Gafar may shift to Home haemodialysis (HhD), which is an edge that KSL has over other outfits.

Gafar said he was treated to services obtainable in developed countries as KSL. He said: “I experienced compassionate care. On offer at the centre is hemodialysis, using the latest dialysis technology in partnership with Gambro and Baxter (Dialysis machine providers oversea.) I browse a lot on my condition and know exactly what to look out for. I had been to most facilities, public and private to undergo dialysis and can say this new entrant has a touch of human. I was contemplating travelling abroad for the transplant, but now, I and my consultant are having a second thought, and possibly we will stick with this centre.”

When The Nation sought out the brain behind the initiative, Dr Emmanuel C. Anekwe, he said he is not in the venture alone but with three partners with the aim of changing the face of renal care in the country.

He said his outfit is changing the face of dialysis in Nigeria by introducing home dialysis (HD-HemoDialysis at home).

“We can take our DaVita machine to the clients’ stables. The rural dweller who can’t afford transportation is helped to obtain vintage renal care at no additional cost. And the high profiled patient also has the ability to travel for work or leisure, while on treatment. The newest home hemodialysis machines are designed to take up less space and require less required storage space. These equipments are portable and designed to provide more portability. In recent years, many people have found that doing HD at home has many benefits. The new dialysis machines are smaller and easier to use, the size of a brief case, making home HD more practical. We are undaunted by the challenge of epileptic energy supply and other challenges like security, but driven by the passion to set the standard because Nigerians with end renal failure are humans, and their situation is not contagious and must not be discriminated against.”

He said: “This was borne out of the inadequacy of the service during our medical training and internships, the exposure to what should be consistent with international standards, the desire to give back to a potentially great country in a sustainable way that is long term and the support of great spouses are the things that motivated us to take huge financial risk and emotional stress to set up this facility. Nigerians are not second class citizens. They deserve the best without having to cut corners with them.

“We took stock of the business environment including the energy situation and we factor in a lot of challenges, and we still realised that quality and affordable services can be provided. So, the new Gambro dialysis machines and high flux-high efficiency dialysis filters; ultrapure water for dialysis, tele-medicine in consultation with specialist partners in Arizona, USA, plus flexible scheduling and private treatment service in a clean and serene environment like this do not have to be expensive. Nigerians should not be ripped off.

He said: “Unfortunately, out of 50,000 patients who should ideally be on dialysis, fewer than 1,000 are on dialysis as at today. It is worrisome.”

Shedding light on the implications of ‘under dialyzing’, Dr Anekwe said: “The best bet is to avoid kidney failure. If three time session of a week is observed, only 15 per cent of what a normal kidney function does is obtained. So three times a week gives a 15 per cent clearance. So once a week or a month dialysis is highly injurious with grave implications. The financial cost is a major concern not only in Nigeria but globally. Developed countries set out to capture more patients for lesser fees; we are setting out to do that as well, as a centre. If you consider money for trips to foreign facilities and the cost of dialysis itself, you will conclude that it can cover more dialysis sessions here locally with getting the same expertise from us here.”

He said: “Granted, a lot of patients have compliance issues which are economically draining. But the standard should not be compromised. Kidney transplant is a ‘permanent’ solution to kidney failure. There are two types of dialysis- hemodialysis and peritoneal. These are not curative but supportive. They are renal replacement therapy. From the financial aspect, transplant is better. But in a situation when dialysis is needed, it must be done three times in a week. Some do once a week or thrice in a month, but the less you do, the more likely you are to end up with more far reaching complications such as cardiac arrest; coronary heart disease amputations.

His worry is that most Nigerians now embrace Westernisation in their lifestyle, especially nutrition. “The diet system has increased the rate of hypertension and diabetes mellitus as fuels for kidney disease. The rate is exponentially high. We already have a clinic to counsel people, even patients with chronic kidney disease because that is still reversible with the right counsel and action. So, anyone who is in any of the five stages of chronic kidney disease is managed to get to the stage where need for dialysis is prevented.

He desired that the government should take up a significant portion of the cost of kidney care as obtained in other climes.

The Managing Partner said management of kidney patients is multi-disciplinary, which explains the plethora of experts in the centre, and as experts they desire to work with the best tools. “That is why we have taken cognisance of rural dwellers and executives in the urban who prefer to get treated at the comfort of their homes and still carry on with their work.

He said the outfit is not a close ended one, “As we are ready to partner with like minds that have the compassion to reach out to renal kidney patients. The company intends to collaborate with health care providers to provide convenient, unique, structured, timely and efficient kidney disease and dialysis care.