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Why over 20m Nigerians are living with kidney problem

By Chukwuma Muanya
10 March 2022   |   2:42 am
Today, March 10, 2022, is World Kidney Day (WKD). More than 20 million Nigerians are living with kidney disease and no fewer than 20,000 of the number are coming down with End Stage Kidney Disease

World Kidney Day

20,000 develops end stage kidney damage yearly requiring dialysis, transplant to live
• People of black African origin four times more likely to develop renal malfunction
• Experts identify hypertension, diabetes, chronic infections as major causes of renal damage in Nigeria
• Costs N600,000 to put one patient on dialysis monthly, N10 million for transplant in Nigeria
• Warn of a spike in cases, deaths in northern Nigeria due to disruption in health services
• Say states investigating situation as CKD of unknown origin

Today, March 10, 2022, is World Kidney Day (WKD). More than 20 million Nigerians are living with kidney disease and no fewer than 20,000 of the number are coming down with End Stage Kidney Disease (ESKD) yearly requiring dialysis or/and transplant to stay alive, according to medical experts.

On second Thursday of March, people across the globe celebrate WKD to raise awareness regarding Kidney diseases. The main aim of the day is to sensitise people about the increasing number of kidney-related diseases across the world. The day also emphasises the need for different strategies to prevent kidney diseases.

The theme of WKD 2022 is “Kidney Health for All.”

Medical experts who spoke to The Guardian said 100 persons per every million population, that is, at least 20,000 people yearly get to the stage where they need dialysis and or transplant. They said it costs N600, 000 monthly to put one patient on dialysis monthly and N10 million for perform kidney transplant in Nigeria.

They identified hypertension, diabetes and chronic infections such as hepatitis B and C, and Human Immuno-deficiency Virus (HIV), sickle cell anaemia, painkillers, and bleaching creams as major causes of Chronic Kidney Disease in Nigeria (CKD).

They blamed the spike in cases of CKD in parts of northern Nigeria, especially in Internally Displaced Persons’ (IDP) camps on disruption in everyday life, especially in health services in the region due to insecurity. They said most people with hypertension, diabetes and chronic infections are not aware and are not accessing treatment because of disruption in health services.

The medical experts, however, said the situation is being investigated as CKD of unknown origin may have surfaced, but requires funds for research to accomplish.

A foremost nephrologist in Nigeria and member of the team that performed the first successful kidney transplant in Nigeria at Nicholas Hospital Lagos, Dr. Ebun Bamgboye, told The Guardian, yesterday: “First of all, this is a worldwide problem. It is estimated worldwide now that at the very least, 10 per cent of our population has one form of kidney disease. The estimate now is that 850 million people worldwide have it. We have found that this is even more common in our environment.

“People of black African origin generally have a greater likelihood of developing kidney problem from all the conditions that eventually lead to it than all the other racial groups. We are four times more likely and the reason being that we inherit the gene known as Apolipoprotein L1 (APOL1) and that gene was originally meant to protected us from trypanosomiasis, that is sleeping sickness, but sleeping sickness is no longer common in our environment but those who inherited that unfortunately are also prone to develop kidney problem. So kidney failure is even more common in black people in environments like America, United Kingdom where you have Asians, Caucasians; almost invariably, black people have a greater likelihood of developing kidney failure.

“Things that easily lead to kidney problem are things like hypertension, which is very common in our environment. About 30 to 40 per cent of adult Nigerians have hypertension. Unfortunately many of them don’t know that they have it and even when they know that they have it, it is not well controlled. They now have the hypertension, they now have the APOL1 gene, they don’t detect it and they don’t control it, they will develop kidney failure. Also, there is diabetes, which is the commonest cause worldwide but not the commonest cause in our own environment, maybe affecting10 per cent of adult Nigerians. Some don’t realise that they may have it. So, they are going around with diabetes and the diabetes is destroying their kidneys and is leading to kidney failure.

“Then of course there are other things like chronic infections that cause chronic inflammation of kidney, what we call chronic glomerulonephritis. In our own environment, it is probably one of the commonest causes and generally tend to follow things like hepatitis B virus, which is common, hepatitis C virus and Human Immuno-deficiency Virus (HIV), which it seems we are getting under a level control. Any chronic infection can lead to this chronic inflammation of the kidney, which also leads to kidney failure. These are the three commonest causes- chronic glomerulonephritis, diabetes and hypertension in that order.

“Then there are other things like sickle cell diseases, things like the abuse of analgesics, abuse of herbal preparation, toxic nephropathies and things like bleaching creams.”

Bamgboye added: “The problem is that we are not detecting them early and by the time we are detecting them, it is at a stage where the kidneys have failed to the extent that you now need to do dialysis and transplant. Easily, about 80 per cent of patients we always detect them at a point where things are so bad that they will need dialysis and transplant.”

The nephrologist said of the 20 million Nigerians living with kidney problem, some of them would be in stage 1, 2, 3, 4 and 5. “In fact what is estimated for any country globally is that chronic kidney disease is in five stages- stage 1, 2, 3, 4 and 5. When you get to stage 5 that is the point where you need dialysis and transplant. But the estimate is that the number of people who get to stage 5, which we describe as End Stage Kidney Disease (ESKD) is estimated to be 100 per every million population. So in essence at least 20,000 people every year get to the stage where they need dialysis,” he said.

Bamgboye added: “Meanwhile, if you look at the total number of people in all the dialysis unit in Nigeria, it is less than 5,000. So in essence, what is happening is that the majority of people who are developing kidney disease many not be able to afford dialysis or transplant, which if you need it and you don’t get it, you will die. So many people are ending up with kidney failure and are dying. So many people may be dying from kidney failure than from malaria and a lot of other conditions in Nigeria.”

In terms of cost, what is the burden in Nigeria? “If someone is on dialysis, he or she needs three sessions every week. Each session of diabetes costs N50,000 and you are going to be spending N150,000 every week and N600,000 every month just to keep the person alive. Of course if you are going to do a transplant, you are looking at N7 million to N10 million in Nigeria. It is more expensive to do it outside,” he said.

On the solution, the nephrologist said: “The solution is that every country realises that there is no way they can bear the burden of ESKD. There is no way you can put 20,000 Nigerians on dialysis every year and you spend N10 million on each of them, that will take the whole of our health budget.

“We all recognise that what we need to do is to focus on early detection and prevention. We know the things that cause kidney problem. Ensure that individuals once they have hypertension it is for life, it is not something that is going to go away. You get them to know that it is not only when they have headache that they have hypertension, majority of times it comes without symptoms. Ensure they start treatment and make sure that these individuals can afford the cost. Like an individual earning N30,000 monthly expected to spend N10,000 on medication. That is why such a person with a disease that is not causing him or her any symptoms will rather use that money to eat or provide school fees for his or her children that treat him or herself.”

Bamgboye said government should recognise that there is need to provide these medications at a cost that is affordable to most Nigerians, especially for diabetes, hypertension and chronic infections.
“You detect and you treat these conditions and that way the number of people that come down with kidney disease will be less,” he said.

The nephrologist added: “First of all treat the primary condition which is hypertension. Make sure that you are avoiding things that are toxic like Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and herbal preparations. Also, you watch your diet- reduce protein and salt in your diet and all these things will help slow down progression. Most importantly have access to experts that know how to deal with the condition.”

On the reported spike CKD in the North, the nephrologist said: “It is not just in the north, it is everywhere. I work in a hospital and we see at least 10 new cases of people requiring dialysis every month. Last year, 2021, the total number of new cases we saw was 169. So this problem is really rampant in our environment and it is not just up north.

“The problem in the north is because of the disruption in everyday life there. Health services have been broken down, hypertension, diabetes and chronic infections are not being detected and treated well.”

Director General, Nigerian Institute for Medical Research (NIMR) Yaba, Prof. Babatunde Salako, told The Guardian that research has shown that chronic kidney disease is more common in young Nigerians compared to the global north where older people are affected. Salako said more males than females, often people in their prime of life and breadwinners of their family.

How many Nigerians are living with kidney disease/failure? “Up to 30 percent of Nigerians may have chronic kidney disease,” he said.

The NIMR DG said: “May be awareness is more for diagnosis, people’s habit and poor environment. Use of drug of abuse seems to be more common now, self medication, poverty and inability to purchase drugs for the treatment of major causes like diabetes, hypertension and nephritis.”

On the rising cases of chronic kidney disease in northern Nigeria, Salako said: “That is currently been investigated as CKD of unknown origin but requires funds for research to accomplish this. Some State governments in the north have taken this proactive step and I believe if they are serious with it they should come up with solution soon.”

On the solution and prevention, the medical doctor said: “Since we know the major causes, all we need to do is create awareness around them to ensure appropriate treatment and availability of drugs to treat these conditions. Screening the population for the risk factors and controlling them among the population is very necessary and key to achieve prevention.”