Patients with kidney disease cry for help as cost of drugs, medical services rise

Ozoemena (not real name) had a kidney disease in 2014. He had several sessions of dialysis before money could be raised to pay for a transplant. To pay for the transplant, money was solicited from various places – churches, relatives, friends and so on.

The family and friends were all happy to have him healthy again after the transplant. But so many of them never knew that it was a new beginning for Ozoemena. He had to be on 12-hourly immune suppressants for the rest of his life. These medicines are very expensive and must not be skipped or his immune system will become very strong again and start fighting the borrowed kidney. The monthly income of the young man before he became sick was barely enough to take care of his family. He and his wife are blessed with four children. The wife was only a petty trader.

First few months after the operation, help was coming from some relatives so there were no problems. Six months after, the young man could not afford to buy the anti-rejection medicines. So he could not continue taking the medications as at when due. He started developing complications. Today, Ozoemena is dead. His death was preventable if only there was help available for him. He is only one of numerous other Nigerians who die daily of issues that could have been prevented.

However, 43-year-old Innocent Nnorom has a different story to tell. Nnorom, married with two children, is now living with a transplanted kidney donated by his younger brother, Chigbo, in 2011.

Nnorom hails from Ihiala in Ihiala Local Government Area (LGA) of Anambra State. He told The Guardian yesterday: “I came into Ozoemena’s picture because I had the rare privilege of travelling to one of the best Indian Hospitals (Apollo Hospitals) for my own transplant. So I get my own medications at far cheaper rate direct from India compared to what they are sold here. So Ozoemena was one of those patients I assist to buy their medicines each time I travel to India. These medicines cost as much as N100,000 monthly for some patients. So you can imagine the situation of patients like Ozoemena in the present economic situation of Nigeria.

“I was at EKO Hospital the other time for my routine checks with my National Health Insurance Scheme (NHIS) card. After seeing the nephrologist, I went to the NHIS office within the hospital to get approval for the prescribed tests and medicines and there, I was given the greatest shock of my life. I was told that NHIS does not cover kidney transplant. I went home disappointed. But God told me something, ‘who knows if it is for this purpose you were allowed to go through the pains of kidney disease so you will be a channel of help to other Nigerians going through such pains’. After prayers I decided to register a foundation through which to continue helping Nigerian kidney disease victims.”

Nnorom said Divine Help Kidney Foundation aims to achieve among other things: continuous education of the general Nigeria community on healthy kidney care; provide the right information to the kidney disease victims; support the kidney disease victims financially by subsidizing dialysis, transplant and anti-rejections; providing continuous orientation to the transplant patients on the do’s and don’ts of life after kidney transplant; continuous solicitation to the government and the corporate bodies for the victims of kidney disease.

He, however, said the Foundation is facing a lot of challenges in meeting its mandate. “We are struggling to get sponsors. We are having financial constraints and lack of co-operation from the victims and their relatives,” Nnorom said.

Nnorom, who is now a full-time evangelist with St Paul Anglican Church Oke-Afa Isolo, Lagos, appealed to the Federal Government to include kidney transplant in NHIS coverage; establish centres where anti-rejections medicines can be given to transplant patients at susidised rates if not free; and set up free dialysis centres across the country.

Meanwhile, part of global efforts to address the problems of people with kidney problems and prevent others from developing the disorder, the World Kidney Day (WKD) was set up in 2006.

Last Thursday, March 10, 2017, is WKD. The WKD campaign aims at raising awareness of the importance of the kidneys to overall health.The theme of World Kidney Day 2017 is ‘kidney disease and obesity: healthy lifestyle for healthy kidneys’. WKD is observed annually on the second Thursday in March. Every year, the campaign highlights a particular theme.

Ahead of the WKD, Nephrologist, raised fresh alert to the growing burden of chronic kidney disease (CKD). They said CKD is very common and between eight to 10 per cent of adult population worldwide have some form of kidney damage, and every year millions die prematurely of complications related to CKD.

Several studies have shown that CKD is a progressive loss of kidney function, which occurs over a period of months or years and when kidney function falls below a certain point, it is called kidney failure.

According to nephrologists, kidney failures are a condition that occurs when the kidneys cannot remove waste or maintain the proper fluid and chemical balances in the body. They say these waste products build up and become poisonous (toxic) to the body making the affected individual feels very ill, and that untreated kidney failure can be life-threatening.

Studies indicate that the first consequence of undetected CKD is the risk of progressive loss of kidney function leading to end stage renal failure wherein there is total loss of kidney function and there is need for dialysis treatment or a kidney transplant to stay alive; and the second is premature death from associated cardiovascular disease – heart attack, stroke, heart failure.

Associate Professor and Consultant Nephrologist, Department of Medicine Lagos University Teaching Hospital (LUTH) Idi-Araba, Dr. Toyin Amira, puts the current estimates of CKD in Nigeria at between 15 to 30 per cent.

Amira said the disease affects the most productive age group of Nigeria’s economy that is between 30 – 50 years, and the common causes of CKD are hypertension, diabetes mellitus, glomerulonephritis, Human Immuno-deficiency Virus (HIV) and obstruction from enlarged prostate.

The nephrologist said in addition to these conditions the use of herbal medications is quite rampant in our community and this also significantly contributes to or worsens existing kidney disease. “Glomerulonephritis (inflammation within the kidneys) is a condition in which the body produces antibodies which attack and destroy the person’s own kidneys,” she said.

Amira said the initial stage of CKD is silent; symptoms appear when the disease is advanced. According to her, some of the symptoms include feeling more tired and having less energy, swollen feet and ankles, puffiness around your eyes especially in the mornings, foamy urine, need to urinate more often, especially at night or reduction in urine output to mention but a few. She, however, said CKD can be treated if detected early, and blood and urine tests are used to check for kidney disease.

What can you do for your kidneys? Amira recommend eight golden rules:
*Keep fit and active- move for health! Exercise for at least 30minutes three times a week. Aerobic exercises are recommended e.g. jogging, bicycling, brisk walking, swimming, dancing among others.
*Blood sugar control
*Blood pressure control
*Avoid smoking and alcohol
*Eat right, eat healthy, reduce salt intake and control weight
*Drink enough water: 1.5 to two litres per day
*Avoid herbal concoctions and abuse of analgesics
*Get your kidney function checked if you have one or more of the high risk factors such as diabetes, hypertension, obesity, parents or other family members suffering from kidney disease and if you are African, Asian, or Australian Aboriginal in which groups this disease is much commoner.

Meanwhile, the World Health Organisation (WHO) has identified obesity as a potent risk factor for the development of kidney disease even as it said that reducing obesity might reverse or slow CKD progression.

The WHO in a statement ahead of the WKD, March 10, 2017, said it increases the risk of developing major risk factors of CKD, like diabetes and hypertension, and it has a direct impact on the development of CKD and end stage renal disease (ESRD): in individuals affected by obesity, the kidneys have to work harder, filtering more blood than normal (hyper-filtration) to meet the metabolic demands of the increased body weight. The increase in function can damage the kidney and raise the risk of developing CKD in the long-term.

Also, as part of its activities to mark the WKD Cedar Group of Hospital in conjunction with the Association of General Private Medical Practitioners of Nigeria (AGPMPN) Amuwo Odofin/Ojo branch have raised awareness to educate the general public about the impending danger caused by the scourge, how to prevent it and also how to take care of the kidney.
WKD aims to raise awareness of the importance of our kidneys to our overall health and to reduce the frequency and impact of kidney disease and its associated health problems worldwide.

Director of Cedar Group Hospital, Adamma Akpabio, in her remarks said that the hospital, which has been in existence since 2001, has been holding the lecture annually, for the past three years as its way of creating awareness for the community.

Akpabio also revealed that kidney diseases have become bad that a lot of people are having it, and there is no much information about it and we think we should bring it up so that people will learn about it have a better knowledge of what is about and can better take care of their selves in case such disease is diagnosed.

She added: “You can also help people around you. If you have information and better equipped, assist people around you. Ours is just to create awareness and let people know about it.”

The Director advised Nigerians to shun medical tourism, boasting that the state of the art dialysis centre at the hospital comes with affordability and within the locality.

Meanwhile, Chief Operating Officer (COO) of Cedar Group, Dr. Chukwuma Ogunbor, said it was a global event that takes place every second Thursday of March and Cedar group founded in 2001 had its dialysis centre established in 2011.

He said the initiative is to give back to the community, create awareness and enlighten the masses on how to take care of their kidney, about kidney diseases and how it can be treated.

Ogunbor confidently highlighted the effectiveness and the affordability of the centre urging the masses to patronise their own in other to reduce medical tourism.

Consultant Nephrologist, Obafemi Awolowo University Teaching Hospital Ile-Ife, Prof. Fatiu Arogundade, said that in Nigeria we have very high cases of kidney diseases and many succumb to it. He outlined obesity as leading cause of kidney failure.

His words: “Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on the health and the major causes can be excessive food intake, lack of physical activity, genetic susceptibility and mental illness.”

The professor also said that one of every five people has kidney diseases, which come in five stages and also that obesity can lead to hypertension and diabetes.

He cautioned Nigerians to watch their weight saying: “The body mass index (BMI) is the index we use to determine whether somebody’s weight is higher than normal body BMI that is 25kg/m2. The optimal weight is between 20 and 25kg/m2. If it is higher than 25, (between 25 and 29) we define the patient as being over weight. The people that are overweight are also exposed to the risk of obesity, even though we define those above 30BMI as obese. Those that are overweight also have the tendency to develop complications that obese individual will develop.”

On the issue of cost of treatment he revealed that they have been working on bringing down post transplant immunosuppressive drugs and very recently they have a conference at OAU where the Minister of Health chaired the session and he echoed the government feelings that they government is concerned in Nigerians dying of kidney diseases and come next year, post transplant immune-suppressor for patients transplanted in Nigeria will be free.

Arogundade added: “For the prevention exercise is very essential, swimming running and jogging brisk walking so as to burn off the calories. We should work for our health and bring our weight down in a bit to maintain a healthy life.”

A study published March 8, 2017, in Nature Reviews Nephrology titled “Obesity and Kidney Disease: Hidden Consequences of the Epidemic” concluded: “The worldwide epidemic of obesity affects the Earth’s population in many ways. Diseases of the kidneys, including CKD, nephrolithiasis and kidney cancers are among the more insidious effects of obesity, but which nonetheless have wide ranging deleterious consequences, ultimately leading to significant excess morbidity and mortality and excess costs to individuals and the entire society. Population-wide interventions to control obesity could have beneficial effects in preventing the development, or delaying the progression of CKD. It is incumbent upon the entire healthcare community to devise long-ranging strategies towards improving the understanding of the links between obesity and kidney diseases, and to determine optimal strategies to stem the tide. The 2017 World Kidney Day is an important opportunity to increase education and awareness to that end.”