Renal Failure: A Time to Act

THISDAY Newspaper- Steve Dada

The rate of renal failure in Nigeria and indeed other parts of the world is becoming alarming. Unfortunately, researchers are yet to get to the root of the increase, let alone find solutions to the scourge. At most healthcare institutions, kidney failure has become one complication that is presented regularly by patients. Ironically however, not much is being done by governments and other stakeholders to ensure that the necessary infrastructure is put in place to provide palliative measures in the event that people suffer kidney failure.

It is believed by many that late President Umaru Musa Yar’Adua suffered kidney related complications which led to the breakdown of other vital organs in his body. Though there is no official information on the cause of his death, it is believed that his kidney related problems played a vital role in his eventual demise. Perhaps his death would spur governments and other stakeholders to action to help patients of renal failure in the country.

According to Dr Ebun Bangboye, Consultant Nephrologists with St-Nicholas Hospital Victoria Island Lagos, if all Nigerians are examined, one out of nine people who walk the streets would show signs of kidney related complications. And Bangboye should know; the hospital where he works is the pioneer healthcare institution in the country. It performs kidney transplants regularly and could rightly be described as the hospital that has seen it all. Sadly however, a new dimension has been introduced into the kidney failure scourge as hospital records show that children as young as six years of age now present with kidney failure.

Due to the inability of governments to fully meet the healthcare requirements of the people, there are always appeals for contributions from the private sector in what is often referred to as Public/Private Partnership (PPP) initiatives. Through such initiatives, the private sector is able contribute as much as it could to help improve the health of the people by uplifting the health sector.

One organisation which has responded positively to this clarion call is Dangote Group. Through a Foundation which it established for such purposes, the organisation recently donated two dialysis machines to the Lagos Island General Hospital. In addition to the machines, the Foundation also bankrolled the cost of consumables and manpower for running the machines to the tune of N21.5 million thereby giving a boost to the PPP initiative.

The machines, which were commissioned by Mrs. Abimbola Fashola, wife of the Lagos State Governor, were donated by the Foundation through the Rotary Club of Victoria Island, to assist indigent kidney patients to access dialysis sessions free of charge over the sponsorship period.

At the commissioning, Alhaji Aliko Dangote, President of the Dangote Foundation, expressed the willingness of the Foundation to continue to partner with the Rotary Club of Victoria Island and other like-minded organisations with demonstrable commitment to the service of humanity, to touch the lives of the people positively.

In his words, “We were persuaded to get involved in this project by the sheer number of persons afflicted with kidney ailments and the huge cost of managing it. We recognise that many Nigerians have passed on simply because they could not afford the cost of long-term dialysis. That is why this project is so important to us.

“We are hopeful that these machines, though not enough to deal with the number of persons who are in need of its services, would at least bring some relief to some patients who otherwise would not have been able to pay for the dialysis sessions. The Dangote Foundation is focused on interventions towards achieving the Millennium Development Goal targets in the areas of health, education and economic empowerment. Our hope is that our contribution would assist our people and nation in making progress in these key areas.”

The donation could not have come at a more opportune time. In the last few years, cases of kidney ailments have increased in Nigeria, leading to a higher demand for dialysis and the attendant increase in mortality rate. Recent estimates put the number of dialysis units in Nigeria at about 27 and it costs an average of N3.2 million for one patient to access the required 3 sessions per week for one year, at a not-for-profit rate.

Kidney failure can present in two forms, the Acute Kidney Disease (AKD) and the Chronic Kidney Disease (CKD). When a patient is suffering from AKD it is believed that if reported on time, there are certain medical interventions that can be applied to reverse the condition in such a manner that the victim can still be able to regain full health and live normal life.
On the other hand, if the case has reached a chronic level, there is little or nothing medical intervention can do to help the situation. At such a stage, the condition is believed to have reached a point at which the kidney can no longer perform its function of filtering out dirt in the body system.

The only remedy at this point is kidney transplant. Through a transplant, the victim will survive on the use of a kidney that could be donated by a person who has his/her two kidneys functioning properly and who may be ready to part with one of such kidneys. In most cases, close relations are expected to donate the kidney as theirs often have higher possibilities of being compatible.

Bangboye said hypertension and diabetes are known common conditions responsible for damage in kidney, stressing that if a person is hypertensive and does not take care of the condition as expected, the end result is kidney failure. He also explained that a person who has diabetes and does not take care of it might end up with kidney failure.
Apart from the two conditions, the Consultant also emphasised the role herbal drugs play in the incidence of kidney failure. According to him, a study carried out sometime ago showed that shortly after trade fairs where alternative medical practitioners have field days to advertise their drugs, healthcare institutions usually experience an upsurge in the cases of people coming to complain about complications relating to kidney disease.

He also mentioned the use of bleaching cream for changing the body complexion, noting that most of such creams contain mercury that can penetrate the body, becoming toxic to the body organs and destroying the kidney.

According to him, people need to be wary of the rate at which they consume fried foods. He stressed that most of such foods coming from fast food joints may not be too good for the body as most of them have been found to contain too much salt that may aggravate incidence of hypertension. The expert decried sedentary lifestyle in which people don’t engage in regular exercise, noting that exercise plays an important role in the good health of humans.

Talking about dialysis, Bangboye noted that where a transplant cannot be immediately carried out, dialysis is an option to flush out the dirt in the system, thereby playing the role of the kidney. Unfortunately, he said, the cost of dialysis is very high as it has to be performed at least three times in a week with each session costing between N25, 000 and N50, 000 per week. He however stressed that it is not even advisable to undergo dialysis for too long, saying that the earlier a transplant is performed, the better.

A Consultant Urologist/Transplant Surgeon, Dr. Ayo Shonibare had, in a lecture titled, ‘Cost Containment in Kidney Transplantation’ identified funding as one of the major challenges in the treatment of kidney failure in Nigeria. He also said there is poor attitude to donation of kidney to the needy, stressing that there is the need to have donor pools in the country so that more people with CKD can have better chances of living. He cited other parts of the world like India where there are ready donors in the event that somebody needs a kidney to survive.

Shonibare condemned the poor level of education and awareness about kidney disease. He stressed that there is the need for the general public to be more aware about the dangers of kidney failure. Such campaigns should include what people should know and the need for regular medical check up to detect complications relating to kidney disease on time. He also noted that there is the need to give adequate training to hospital personnel on management and care for patients with kidney disorder.
The surgeon talked about poor renal registry in the country. he said there is poor record keeping about the number of people attacked by renal failure in the country unlike in other parts of the world and advised that Nigeria should collaborate with local and international centres on issues relating to kidney disorders.

There is however the need to intensify research activities to nip the problem in the bud. With research, the nation may be able to get to the root of the escalating incidence of kidney failure and remedies could be proffered to reduce the spread.
Tracing the history of the treatment of renal failure in the country, he noted that numerous attempts to start renal transplantation failed but the first dialysis centre started in Lagos University Teaching Hospital (LUTH) in 1981, blaming the rapid deterioration in public healthcare system as a major obstacle. He also mentioned the slow but steady growth in private healthcare industry and the cost of dialysis, which according to him, is high. But he noted that alliances with drug companies and kidney foundations that would monitor renal registry are all needed measures to adequately care for kidney failure patients.

On education and awareness creation in the country, Shonibare said the media has a very important role to play as he called for donor subsidised managed care scheme. Part of the new strategies, he suggested, should be government intervention as, according to him, the cost of caring for and treating kidney failure patients is beyond individuals. He further stressed that various teaching hospitals should create autonomous units and called for an Act of the National Assembly on organ transplantation.

He appealed for strong advocacy groups and highly innovative fund raising campaigns, while calling for a highly motivated workforce that will adopt the spirit of ‘team work’ and abandon ‘big man’ syndrome at the hospital level. As part of measures to reduce cost, he called for early transplantation and reduction in the length of hospital stay; encouragement of live donor programmes as well as voluntary donations before death. He called for serious efforts to minimise post operation complication rates, insisting that strict post operation follow up should be adhered to.

A lot still needs to be done to help renal failure patients. One fact is however obvious; in spite of the fact that the disease is on the increase, information about it is sparse. This seems to be one of the major reasons for its continued rise. Because people are unfamiliar with the condition, they often miss vital signs and go to hospital only when it is already late. So, as argued by Bangboye and Shonibare, education is of vital importance. Then of course, governments and other stakeholders need to do more to make life better for people with renal failure. More dialysis machines are required and a lot more needs to be done about donation of kidneys and other vital organs. To arrest the dangerous rise in renal failure cases, it is time to act.


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