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Access to kidney care critical for Nigeria to “live well” with kidney disease: World Kidney Day 2021

By Gabriel Oke and Hadiza Mohammed (Lead Writers)

World Kidney Day is celebrated every year to create awareness about kidney diseases and advocate for care towards people who are living with any stage of kidney disease. The day serves as a day to drive conversations and communicate the benefits of healthy living.

Over 2 million people worldwide are currently receiving treatment for a kidney disease either with dialysis, a process of removing waste products and excess fluid from the body or a kidney transplant but the good news is that kidney diseases can be prevented as long as we take good care of our kidneys. People with chronic kidney disease are able to live long lives without being unduly affected by the disease.
 
In Nigeria, the leading causes of kidney disease are high blood pressure, diabetes and kidney inflammation. Other causes of kidney disease include high cholesterol, kidney infections, kidney stones, polycystic kidney disease, environmental pollution, unsafe drinking water and abuse of painkiller medications. Older people and individuals who smoke or are obese have a greater likelihood of developing chronic kidney disease. Low birth weight due to maternal nutritional status is associated with kidney disease. The symptoms of kidney problems may include swollen face or swollen hands, feet or legs, sudden pain, changes in urine appearance, and frequent urinary tract infections. People with kidney failure may experience nausea, vomiting, weakness, confusion, difficulty concentrating and loss of appetite. Kidney infection can be detected using a urine sample to test for microorganisms, blood or pus in urine. The health of the kidney can also be tested by collecting blood samples for kidney analytes like electrolytes, urea and creatinine.

Image Credit: Nigeria Health Watch

Dr. Abdulsaheed Sakir Iliasu, a specialist in Kidney care and Management at the National Hospital Abuja, in an interview with Nigeria Health Watch, said the cost of dialysis sessions ranges from N21,000.00 to N27,000.00 in Nigeria despite government subsidy. This makes it difficult to attain the global standard recommendation for dialysis which is three sessions a week for 3–5 hours on average. Research among 101 people who are taking dialysis sessions at Ekiti University Teaching Hospital’s dialysis centre discovered that none of them could afford the payment of three sessions per week for three months but could only afford six sessions paid for through their National Health Insurance Scheme (NHIS). Meanwhile, a number of patients were lost to follow up during this period due to reasons which may not be unrelated to financial constraints. Apart from that, only a few Nigerian tertiary health facilities have functional dialysis treatment centres, and the cost of a kidney transplant is also very expensive.
 
The Annual World Kidney Day is an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. The theme of the 2021 celebration is, Living Well with Kidney Disease”. This is to increase education and awareness about effective symptom management and patient empowerment, with the ultimate goal of encouraging life participation.
 
The burden of kidney disease is common among the elderly living in low and middle-income countries as about 80% of the chronic disease burden occurs in low-or-middle-income countries, and 75% of the burden occur among people above 60 years.
 
The kidneys are like filters that sieve out toxins, excess water and waste products from the blood and store them in the bladder, to later be expelled through urine. Kidneys regulates the level of acidity and basicity of fluids in our body, salt level, and potassium levels in our body. They produce hormones that regulate blood pressure and control the production of red blood cells. When there is a problem with the kidney, it causes kidney disease.
Acute kidney disease occurs when kidneys suddenly stop working or when the blood flow to the kidneys is not enough. It also happens when there is direct damage either by a physical injury or a disease like diabetes, high blood pressure, or other disorders to the kidneys or when urine is backed up in the kidneys without being expelled.
 
Chronic kidney disease is a progressive and longstanding disease which jeopardises survival and quality of life but can be managed therapeutically by renal replacement therapy — used to support patients with renal failure and is occasionally used to perform the functions of the kidney. One of the important techniques used in RRT is dialysis. The longstanding disease of the kidneys can lead to renal failure. Chronic kidney disease often has no symptoms in its early stages and can easily go undetected in most people until it is in its advanced stages.
 
 It is estimated that people receiving renal replacement therapy will keep increasing in Nigeria and Asia more than other parts of the world if huge steps are not taken, and the number of people without access to renal replacement therapy is projected to also increase concurrently. Dr. Iliasu also said, ‘‘Renal care in Nigeria is quite challenging and expensive and the number of healthcare specialist for Kidney care is also not enough.” Dr. Iliasu mentioned that the usage of traditional herbal medicine is a common issue among disadvantaged populations. Nephrologists are scarce in Africa, and this might worsen as health professionals continue to migrate across the board to other countries.

Image Credit: Nigeria Health Watch

People are sometimes unaware that kidney disease can often be prevented. Kidney problems can be prevented by making healthy food choices such as fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Serious kidney disease may lead to complete kidney failure and the need for dialysis treatments or a kidney transplant to stay alive.
 
Managing kidney disease has been complicated by the coronavirus pandemic. It is one of the underlying ailments that worsen the prognosis of people with the virus. People who have chronic COVID-19 symptoms can form tiny clots in the bloodstream, which can clog the smallest blood vessels in the kidney and impair its function. Dr. Iliasu noted that people hospitalised with COVID-19 are at significant risk of acute kidney injury, which can lead to serious illness, noting that COVID-19 has contributed to the surge in number of kidney diseases. He added that people living with kidney diseases have suppressed immune systems, which puts them at a high risk of coming down with infections.
 
Experts have been advocating for coverage of chronic kidney disease patients in the National Health Insurance scheme. This will prevent the burden of out-of-pocket expenditure for tests and management of kidney diseases. Also, more chronic kidney disease screening centres across the country will help early diagnosis and improve outcomes for patients, as well as more RRT centres and increased public awareness by government and community-based organisations. Training and retention of more specialists like nephrologists and nephrology nurses will ensure patients can access quality care without having to travel to other countries.

Image Source: Times Now News

Maintaining healthy kidneys requires that individuals adhere to preventive measures such as controlling their sugar intake, regular exercise, monitoring their blood pressure, and limiting the intake of pain killers.
 
Living with kidney disease should not be a death sentence. Nigerians with kidney disease deserve to participate in life and not have their social interactions interrupted. This is the goal of the 2021 World Kidney Day.

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