Chronic kidney disease (CKD) is a global problem with increasing prevalence in different parts of the world, including Nigeria. In the country, End-stage renal disease (ESRD) accounts for eight percent of all medical admissions and 42 percent of renal admissions. Figures indicate that over 35 million Nigerians are suffering from various stages of kidney disease with an estimated 15,000 new patients diagnosed yearly. This high prevalence of CKD in the country, has been attributed to several factors, according to medical experts.
This includes hypertension, diabetes mellitus, some herbal medicines, obesity, low level education and illiteracy.
Indeed, a study conducted by a medical team namely Ifeoma I Ulasi, Chinwuba K Ijoma, Obinna D Onodugo, Ejikeme B Arodiwe, Ngozi A Ifebunandu and Julius U Okoye and published in 2013 in Kidney International Supplements, (the official journal of the International Society of Nephrology), identified hypertension as one of the commonest causes of CKD, especially in people of African descent. The study recorded an overall age- and sex-adjusted prevalence of 26.1 percent (30.1% and 18.9% in the semiurban and rural communities, respectively). ‘These figures are high, underlining the risk of CKD if blood pressure is not adequately controlled. A high prevalence of hypertension had been consistently documented in various populations in Nigeria,’ the study noted.
The study also points at the role herbal medicine plays in fuelling kidney failure in the country. “Many herbal remedies have been proven to be nephrotoxic. A typical example is remedies that contain aristolochic acid in some Chinese herbal medicines,” it stated.
While noting that the use of traditional herbal medications is common in Africa, the study postulates that nephrotoxicity resulting from their use accounted for 37.5% of cases of acute tubular necrosis in a Nigerian study. In Kenya, East Africa, about 11% of cases of acute renal failure were attributed to traditional herbal remedies while in South Africa, use of herbal medicine was identified as the commonest medical cause of acute renal failure.
Supporting this view, Dr Wunmi Abiola of the June One Hospital, Opebi, Lagos, blamed the high rate on ‘medications that are harmful to the body.’
Dr Dan Gadzama, Consultant, Primary Health Board, Abuja, in his view, opined that certain lifestyle habits are contributing to the high prevalence of CKD in the country. “Most of the things that cause renal failure are abuse of analgesics, sedentary lifestyle that leads to obesity which leads to hypertension and diabetes; these being major risk factors for renal failure,” he noted. To avoid having kidney disease, he advised lifestyle adjustment. “Lifestyle modification is very important in preventing the disease,” Gadzama added.
His advice is worth taking considering the seriousness of kidney disease, and its treatment. Diagnosis of kidney disease especially end stage kidney failure can be devastating, placing severe financial, physical and emotional burden on the sufferer.
On this, Gadzama stated: “Treatment of renal failure will depend on what is causing it and the worst case scenario is for the patient to have a renal transplant.
“Of course it is expensive. I do not even think that there is a renal transplant centre in Nigeria, and that should go a long way to tell you how expensive it is. To get it done, the patient is likely to travel outside the country.”
It’s not just the transplant that costs a large sum of money. Dialysis, which helps the kidney to work, where it is not functioning, does not come cheap. A session can cost as much as N30-35,000 and this needs to be done about thrice a week. It is no wonder that out of 50,000 patients who should ideally be on dialysis, experts put the number of those on dialysis at less than 1,000.
“Dialysis is not affordable for the ordinary person. It is expensive,” affirmed Dr Gadzama. “The good news about dialysis is that it can be done in Nigeria; a good number of places can do that. Dialysis is done just to try to buy time. You do dialysis to sustain the patient pending the time that you can get a donor and when the patient can afford a transplant.
‘’When somebody is on dialysis, there are some drugs that the person will have to be on and in most cases these days, there are treatments that can be administered and the patient will still be able to move around. But in most cases also, as a lifestyle, a patient will have to avoid high protein diet because it adds a lot of load to the kidney-that is, animal protein like meat, egg and so on,” noted the medical practitioner.
The kidneys’ functions, he noted, are to filter the blood, remove wastes, control the body’s fluid balance, and regulate the balance of electrolytes among other functions. In other words, it’s the body’s waste disposal system. The kidneys are so important to the body’s wellbeing that if both kidneys fail, as happens in end stage kidney failure, the body dies without life saving dialysis.
Besides the high cost of treatment, inadequate facilities, especially dialysis centres and drugs for post transplant treatment among others, add more to the burden of sufferers. Cases abound where patients with renal failure travel from different parts of the country to Lagos for dialysis and other treatments which are unavailable in their domain.
It’s in light of this that pundits have called for more dialysis centres in the country as well as the Federal Government to include the cost of dialysis as part of the treatment that Nigerians can access under the National Health Insurance Scheme.
On a personal level, health experts advise a healthier lifestyle as a way of reducing the risk of chronic kidney disease. “Certain lifestyle changes are essential to reduce the risk of CKD,” stated Dr Maxwell Ogwah, a medical practitioner. These he said, include avoiding ‘self-medication’, especially analgesics, antibiotics and other pain killers and over-the-counter (OVT) drugs. “If you are sick, go to the hospital and get tested. That’s the only way to know what ails you. But for some people, once they have a fever or headache, they conclude it’s malaria and they go to the local chemist down the street and buy drugs which they take. This is dangerous. Taking drugs without prescription, especially for a prolonged period, can lead to kidney damage,” he said.
He also advised drinking alcohol in moderation, avoiding smoking, avoid use of herbal medicine that has not been clinically tested to be safe for use, maintaining a healthy weight to avoid diabetes and high blood pressure and eating healthily with regular exercise.
