In recent times, chronic kidney disease (CKD) has emerged as a major public health challenge, with the prevalence of kidney failure rising globally. The Global Burden of Disease project reports show that diseases of the kidney and urinary tract, accounting for nearly 850,000 deaths annually. Besides contributing to global burden of diseases, kidney disease has become a major threat to national Gross Domestic Product (GDP) of developing nations, including Nigeria.
One potential outcome of CKD is end-stage renal disease (ESRD), requiring costly renal replacement therapy in the form of dialysis or transplantation. With ESRD remaining a major cost driver for health-care systems, with annual growth of dialysis programs ranging between 6 percent and 12 percent over the past two decades and continuing to grow, particularly in developing countries, sufferers of ESRD in Nigeria pay between N75,000 to N100,000 weekly to undergo dialysis section.
With majority of kidney patients accessing healthcare through high out-of-pocket payment for health, the non-regulation of dialysis centres in the country further poses great risk to kidney patients, a situation that can result to high mortality rates if not checked.
Speaking with BusinessDay during a free kidney check by the hospital to mark the World Kidney Day in Lagos, Ebun Bamgboye, clinical director, St. Nicholas Hospital, Lagos, said there is a need for the Federal and State governments to regulate the activities of dialysis centres in the country to avoid high mortality rates in renal clinics and ensure that there are trained nephrology and dialysis personnel to man such centres.
With non-regulation of activities of dialysis centres in Nigeria posing great risks to kidney patients, Bamgboye, who is also president, Nigerian Association of Nephrology, criticised what he described as increasing rate of organ trafficking and medical tourism in the country, just as he called for an effective legislation against the practice.
“We know there are units now that would dialyse a patient but only for the money. There are some that still go ahead to dialyse someone that cannot withstand the process and the outcome is usually negative. There are centres that would use inappropriate consumables in an inappropriate time.”
“Dialysis, to some extent, is a simple procedure and to some extent technical. You need to be appropriately trained as a doctor, nurse or technician to be able to do it safely without any adverse effects on the patient. So, there is need to have some form of regulation,” Bamgboye explained.
The clinical nephrologist urged government to encourage local centres in the delivery of transplantation services by funding and enhancing capacity development in order to reduce capital flight as a result of the medical tourism.
Bamgboye called for increased awareness of the simplicity and advantages of peritoneal dialysis and appeal to the authorities concerned to help in granting import duty waivers in sourcing for peritoneal dialysis fluids, relevant technology and consumables. “Local production peritoneal dialysis materials should also be encouraged,” he said.
BusinessDay investigations show that the National Health Insurance Scheme in the country provides between 3 to 6 dialysis sections for people covered in the scheme. With about 36 dialysis sections (3 months) gestation period needed to establish an individual has ESRD, a patient under the NHIS scheme is to access the remaining 24 dialysis sections through out-of-pocket payment, to the tune of between N600,000 to N840,000.
With 16 million (10 percent) of Nigerians suffering from kidney disease, there are currently 76 dialysis units all over the country. A breakdown of distribution of renal units in the country shows that Lagos has 20 dialysis units (5 public, 15 private) with 2 transplant units (1 private and 1 public).
Other South-West states have 10 dialysis units (7 public and 3 private) with 2 transplant units that are publicly run; Abuja has 8 dialysis units (4 private and 4 public) while the 11 Northern States have 14 dialysis units and 3 transplant units which are publicly run.
The South-South States have 12 dialysis units (7 public and 5 private) while the South-East States have 12 dialysis units (5 public and 7 private). However, these regions do not have any kidney transplant facility.
This year’s WKD theme is ‘Kidney age, just like you’ marked annually on March 13, is a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF), with NAN as a member.
Alexander Chiejina
