Tag: Prof. Onyebuchi Chukwu

Experts have raised the alarm over the rise in number of those with kidney failure worldwide.

The number have risen from 1.5 million to three million, they said at a forum in Lagos organized by St Nicholas Hospital in collaboration with the Chief Moses Adekoyejo Majekodunmi Foundation (MAMF).

The experts include Minister of Health, Prof. Onyebuchi Chukwu; eminent urologist and Transplant Surgeon at Fortis Hospital, Bangalore, India, Dr. Mohan Keshavamurthy; Consultant Nephrologist and Medical Director, Ibadan Hypertension Clinic, Prof emeritus Oladipo Akinkugbe; Provost, College of Medicine, University of Lagos (CMUL), Prof. Folashade Ogunsola; Vice Chancellor, Lagos State University (LASU), Prof. John Obafunwa; Lagos State Commissioner of Health Dr. Jide Idris; Ogun State Commissioner of Health Dr. Olaokun Soyinka.

They called for regular public enlightenment sessions on chronic kidneydisease (CKD) and end stage renal disease (ESRD), adding that the government should improve the socio-economic status of Nigerians; ensure good sanitation and literacy; enact an Organ Transplant Act; establish a National Renal Registry and Kidney Transplant Programme; expand the National Health Insurance Scheme (NHIS) to accommodate patients with kidney failure; develop a data bank for disease donour transplant and subsidise costs of immunosuppressive drugs.

The experts said people get CKD and ESRD because of the increase in abuse and indiscriminate use of herbal concoctions, bleaching creams and soaps, alcohol, hard drugs and smoking, adding that most people living with Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), were in the low socio-economic status (Gross Domestic Product – GDP) of the country.

In a paper titled: Renal Transplantation at St Nicholas Hospital, the journey so far, Dr Ebun Bamgboye, Head, Dialysis/Transplant Unit of the hospital, said the number were ‘just spiraling.’

He said: “In 1990, we probably had fewer than half a million people on dialysis, by 2000, the number had increased to 1.5 million. Currently, we know that close to three million people with different forms of CKD and ESRD are all around the world. Unfortunately, those in developing world, particularly sub-Saharan Africa, are not coping well unlike in North America and Europe where they are able to cope with over 1,000 patients per a million. The number of patients in Africa that are benefitting from therapy are less than 50 per million and this is not because we don’t have patients with CKD.

Bamgboye added: “We know that there is a clear association between your GDP per capita and the number of patients you are able to provide care for. If you look carefully, you will also see that it reflects on your life expectancy, which has gone up to about 52 years in Nigeria.”

He cited reasons for the prevalence of the disease in Nigeria, saying: “We know that race, ethnicity and genetics have roles to play. You know that CKD tends to be two to three times more common in men than women. You know that the older you get, the greater the likelihood that something will go wrong with your kidneys.

“We also recognise that there is spiral increase in patients with diabetes. It is estimated that very soon, we would have doubled the number of diabetics in the world and the number in Nigeria, which incidentally was only about two per cent is now in Lagos; it is estimated that about eight per cent of our population are diabetic. Also, hypertension, obesity are increasing; we have all become urbanised, and no one wants to live in the villages again.”

He added: “In developed parts of the world where studies have been done, it has been shown that when you compare people from Africa with those from other ethnicgroups, you find out that the black race for some reasons is more predisposed to CKD than any other.

“Hypertension is twice as likely to cause a stroke in black men, twice as likely to end up with a heart failure and four times more likely to end up with kidney failure. In the United States where blacks are only about 15 per cent of the population, they constitute almost 60 per cent of patients on dialysis in that country.”

To avoid CKD, Akinkugbe said: “We must go a step further on the economics of health. Hippocrates has taught us. The complexity of kidney transplantation is a global thing. It is not just incumbent in Nigeria. In more advanced countries you still find the problem. Since, we began transplantation, we have done less than 200. The implication is that if we look at the etiology of CKD that is the cause, the three major causes chronic glomerulonephritis, hypertension and diabetes. If you look at the etiopathogenesis, what are the causes? We will probably be saving thousands of lives. Etiopathogenesis is the cause and development of a disease or abnormal condition.

”Glomerulonephritis is a very expensive form of disease to treat and its management, treatment affordability is beyond the generality of the population in the developing world not just in Nigeria. Therefore, what should we do? One must begin seriously to look at etiopathogenesis and I think this is where the Foundations become relevant because if you combine end stage management of kidney disease and transplant to looking at what actually causes it, why is the incidence so high in this part of the world compared to the black race.’’

He added: “There must be a reason and to that reason I charge the foundation to perhaps devote sometime on this. Maybe by awarding research grants, you can break new grounds that will lead to the solution to the ethiopathogenesis. Then you would have solved the problem not only for Nigeria, but to the rest of the developing world. That is the challenge I will like to throw at researchers, which will make the totality of the efforts more effective. I think we should focus more attention on the beginning rather than the end of these conditions.”