KIDNEY disease is a worldwide problem but the magnitude in Nigeria is in a world of its own. The burden of physical, emotional, social and financial complications are in a different class altogether. End Stage Kidney Disease is the worst aspect. The requirement of a kidney transplant often marks the end of the road for quite a large number of Nigerians because the cost of management is prohibitively high.
Management of any sort of kidney disease is impoverishing not just to the patient but also the family. There are hundreds of thousands of patients and their families have sad tales to tell.
Take the case of Stella Emmanuel. After she was diagnosed with ESKD, she ended up selling her house and spending her life time savings in a bid to pay for a kidney transplant.
It all began with an episode of typhoid fever. Life became meaningless to her as her sickness continued unabated. From then Stella was placed on life time dialysis – three times a week just to stay alive.
Stella’s kidney problem became apparent after she passed a job interview and was undergoing medical assessment. The doctor apologetically announced that the company could not take her on because she had protein in urine.
The dialysis was being done at St Nicholas Hospital, Lagos for which she paid N35,000 per session amounting to N400,000 – N500,000 monthly until 2010, when she kidney transplant done in India.
In a way Stella was lucky. Her aged mother gave her another chance of life by donating a kidney to her.
“By the time you have the transplant; you need to take your tablets and steroids to ensure that your body does not reject the new kidney. But how many people can afford that?
“I sold my house in Lagos to afford a life time dialysis and transplant. My greatest joy today is being able to find a matching donor within the family. My mother who at the time was about 68 years gave me one of her kidneys. Basically, I got another chance with life.”
Stella however, claimed that apart from the financial implications, ignorance and difficulties in getting donors is also a serious challenge.
The case of Rafiu Abdulkareem, 47, is similar. Rafiu is seeking over N8 million for an urgent kidney transplant. He is currently on life time dialysis thrice weekly. He spends N100, 000 every week on dialysis at the newly built Lagos State Cardiac and Renal Centre.
His ordeal began in March 2015 after he developed a strange cough in the middle of the night. A medical report signed on behalf of the Medical Director, Renal Unit, by Dr. Bomi Omowo, said Rafiu is currently being managed for advanced Chronic Kidney Disease, CKD, secondary to undiagnosed hypertensive nephrosclerosis and being managed as a case of end stage renal disease.
Rafiu’s wife, Sofia, a school teacher, says they cannot afford to pay for the treatment. Tearfully, she recounted how they have resorted to begging.
“Every week we spend over N100, 000 on dialysis alone. Each session costs N37, 500. Even today, there was no money. I ran from one room to another begging for help and till this moment, we don’t have the money complete. We have sold all our assets, this is September, I’m not sure if my four children will even go back to school.”
Kidney disease patients face the same fate across the nation. Mohammed Abubakar, a kidney survivor, however says beyond the high cost of treatment and transplants, patients are faced with challenges of sustaining post-treatment care as they are expected to be on drugs and ensure regular checks from time to time for the rest of their lives.
He said the lack of support or insurance is the No.1 killer of kidney patients in the country because many cannot afford treatment.
“My transplant was financed by myself. After the transplant, things changed. I cannot do as much as before. I was warned not to strain myself and I have been on drugs since the surgery. Daily, I take drugs five times. To date, I don’t know who paid the initial US$15,000 the Indian hospital demanded before I was given my visa. I usually go to India for check up with not less than US$10,000 because I must buy the drugs that will last one year. The drugs are not cheap. I have been able to cope with the assistance of my church and my family.”
The stories of Nigerians affected by kidney disease are in exhaustible. At a recent forum of the National Council on Health, the disturbing rise in kidney failure incidents in the country was a concern. Yobe State reportedly accounted for 35 per cent of the cases nationwide while Lagos State also featured prominently as one of the kidney failure prone states. Also, at a similar forum in Lagos, the Commissioner for Health, Dr Jide Idris linked the rise to indiscriminate consumption of herbal medicines popularly known as agbo and alcoholic beverages.
Burden of kidney disease
Statistics by the Nigeria Association of Nephrology shows that about 36.8 million Nigerians, (23 percent) of the nation’s over 170 million population, are suffering from various degrees of kidney diseases.
An estimated 15,000 new patients are diagnosed every year in the country even as children are now the most hit. In a study conducted between 2008 and 2011 at the Lagos University Teaching Hospital, LUTH, kidney- . diseases accounted for 8.9 per cent of paediatric admissions, with a prevalence rate of 22.3 admissions per 1000 child admissions per annum. Yearly incidence also doubled during the study period.
However, many factors have been adduced to the disturbing trend of the disease. Some include untreated microbial infections, especially urinary tract infections, diarrhoea, malaria, hepatitis, diabetes, hypertension, potassium bromate poisoning, abuse of painkillers/ analgesics, particularly paracetamol amongst others.
The Chief Executive Officer, Kidney Clinics Nigeria Limited, Abeokuta, Ogun State, Mr. Adebayo Sokunbi, who lamented that Nigerian dialysis patients and their families are suffering greatly said out of 120,000 cases diagnosed annually, only 400 patients are on regular dialysis.
In a month, dialysis centres attend to at least 50 persons. Sokunbi said at Kidney Clinics, Abeokuta Dialysis Centre, an average of about 60 sessions are done monthly. “Nationwide, we have no accurate data but most of the centres are in Lagos, Ibadan, Abeokuta, Abuja and Kano among others.
Managing kidney-. diseases is expensive and complicated in Nigeria and even abroad.
For those that are able to afford to seek expert or specialist medical attention abroad, it has been estimated that they spend over N120 billion annually on foreign medical tourism, while about 5,000 patients travel to India monthly for treatment of various diseases, including kidney challenges.
The Medical Officer, Kidney clinics, Abeokuta Dialysis Centre, Dr. Idris Olatunji, notes that more patients are dying in Nigeria essentially due to cost and late presentation at the hospital, hence most present as a case of chronic kidney disease (CKD) which is “irreversible” kidney damage.
“High cost of dialysis and kidney transplant is a cause for worry. When patients present late chances of getting better outcome are slim. That is why it is important to cultivate the habit of regular checkups where some of these problems could be picked up early. “Kidney disease had always been an epidemic worldwide however many deaths were undiagnosed.
Idris who believed that recent increase in kidney disease is as a result of more awareness and reported diagnoses blamed most cases on uncontrolled hypertension, uncontrolled Diabetics mellitus, congenital anomalies, nephrotoxins and others such as obstructive uropathy.
Olatunji explained that dialysis is a temporary management and kidney transplant is the treatment However, to maintain a transplant is also very expensive as its cost is throughout life as also dialysis but transplant gives the patient his/her life back. He said only patients whose monthly income surpasses cost of dialysis for a month can financially sustain regular dialysis sessions.
A CKD patient requires thrice per week dialysis estimated at N100, 000 weekly. Such patient can remain on dialysis for as long as he/she can afford it, but CKD is a terminal illness without kidney transplant.
Olatunji who stressed the need for government to subsidise the cost of dialysis said: “If subsidised a bit, it will improve health and quality of life of kidney patients.”
“Dialysis takes a direct toll on patients and their family members due to its high cost and the fact that they have to pay out of pocket to access care. Often then have to stop work to take care of their loved ones and this also becomes an additional burden.
Contrary to speculations on challenges of organ donation and racketeering, Olatunji said the only issue concerning organ donation in Nigeria is getting “the right March.”The two common types in Nigeria (there are other types): living “.” donors and living “unrelated “donors
The donor and recipient goes through series of test to confirm their compatibility which is significant before any transplant could be done. Getting a donor is not a major issue in Nigeria but cost.