Time for change in approach to kidney disease, says Commission

-as gov’t moves to establish Centre of Excellence for transplants

Guyana’s Presidential Commission on the Prevention and Control of Non-Communicable Diseases (NCDs) says it’s time for a change globally in the way kidney diseases and injuries are addressed

The Commission in a release yesterday, World Kidney Day, acknowledged that globally, after March each year, there is a return to business as usual and little attention is paid to chronic kidney diseases (CKD), a major public health challenge.

It explained that CKDs affect just over 10 per cent of the global population, leading to death and disability and represent one of the major global disease burdens. Further, there are also increasing incidences of acute kidney injuries (AKI). Given that diagnosis, treatment, and care, represent a major cost for public health sectors in Guyana and around the world, the release opined that the time has come for every single day to be World Kidney Day, and the time has also come for a revolution in the way the world addresses the problem of CKD and AKI.

The Presidential Commission therefore urged more equity in access to kidney replacement therapy (KRT) as a significant percentage of persons living with CKD will require KRT. It pointed out that most Guyanese and most people around the world know KRT as dialysis and kidney transplants.

Theoretically, it noted, dialysis is supposed to be a temporary fix, with the hope that kidney transplant will end the patient’s agony. But the truth is that for people in most countries today, a kidney transplant is not accessible. For developing countries where kidney transplants are available, access is limited. But even dialysis is limited in most developing countries and there are still countries that have no access. As such, there is need for a revolution in which KRT becomes commonplace and no country is without access.

The Commission observed that Guyana has made ‘tremendous improvement’ in access to KRT. Further, the kidney transplant programme has grown significantly and in 2024 a Centre of Excellence for Kidney Transplant will be established at the Georgetown Public Hospital with the help of the University of Calgary and other partners. The Commission also commended the Ministry of Health for ensuring Guyana creates equity in access to KRT.

Also mentioned was the new digital pathology lab that will build capacity for HLA [human leukocyte antigen] testing in Guyana and enable the introduction of deceased (cadaver) donation kidney transplants. This means that kidneys from deceased persons can be used for the first time in CARICOM for transplants.

The release reminded that it was only in July 2021 that the Dr Kishore Persaud-led team performed a kidney transplant on the first patient from the Caribbean Community (CARICOM) to benefit from the Guyana Transplant Centre, an initiative towards Tourism Medicine. It was also in December 2023 that the team performed the first paediatric kidney transplant, transplanting a father’s donated kidney into a seven-year-old girl with this being the youngest child to have benefitted in the entire Caribbean. Furthermore, the same team also recently successfully performed the first laparoscopic donor nephrectomy to procure the kidney for transplant.

Touching on the issue of dialysis, the release informed that dialysis access has expanded to regions Two, Three, Four, Six and Ten, and persons from other regions can access with government support dialysis centres in these regions, with the Commission calling for the introduction of dialysis centers in all regions of Guyana.

It informed that to support dialysis, each person on dialysis is provided with $600,000 per year to support access in the private sector. In addition, laboratory testing and medicine costs are in excess of $1 million annually per patient.

These, the Commission noted, are commendable initiatives, while stressing that Guyana’s goal must be that every citizen in need of dialysis must gain access without creating family poverty.

The Commission also urged an end to inequity in early detection of kidney diseases. Simple testing for HBA1c, AlbuminCreatinine ratio and eGFR are not easily available to people, and as such, the global kidney health revolution must include universal access to such simple testing. “Guyana must work towards universal access to such simple testing, bringing these within the ambit of primary health care”.