Why chronic kidney disease is highest among young adults in Nigeria
CWhat is chronic kidney disease? hronic Kidney Disease (CKD) is a condition where kidney damage occurs gradually over a long period and can lead to permanent kidney failure. The condition progresses slowly over at least three months and may go completely unnoticed. It is classified from Stage 1 to 5, with stage 1 being early, and stage 5, also known as end-stage renal disease (ESRD), being the final stage.
The stage of the disease is assigned based on the level of kidney function – irrespective of the underlying cause. In the early stages of the disease, you will not have any indication that something is wrong.
Why is the incidence of CKD high in Nigeria?
The precise incidence of CKD in Nigeria is unestablished due to absence of population-based studies and lack of a national kidney disease registry. Several studies report that the incidence of CKD in Nigerians is very high.
Estimates suggest that 30 to 50 million Nigerians have CKD. The high incidence of CKD in Nigerians is attributed to a high prevalence of hypertension, diabetes mellitus, infection-related glomerulonephritis, chronic analgesic use and ingestion of herbal concoctions.
Excess burden of CKD among young adults in Nigeria - Why?
The most disturbing finding about CKD in Nigeria and the rest of subSahara Africa is that it is predominantly found in young adults (ages 20 to 50 years) in their most productive years. By contrast, the average age of new dialysis patients in the United States is 64 years.
There is insufficient population-based data on CKD in Nigeria to explain the disproportionate burden among young adults.
It is speculated that the major causes of CKD probably occur at an earlier age in Nigerians and often goes undetected and untreated. Furthermore, many patients presented very late with advanced CKD. Because of their late presentation, most never had the opportunity to be evaluated by a kidney specialist to search for an underlying cause that may be treatable. In fact, many patients with ESRD in Nigeria remain undiagnosed, untreated and die.
Lack of awareness of CKD in Nigeria
CKD awareness among Nigerians is very poor. A recent survey revealed that majority of Nigerians do not know the correct location of the kidneys and only about one-third had heard of CKD.
More horrifying is the belief among many surveyed that herbal concoctions cure CKD – a practice that will expose failing kidneys to unregulated products, some of which may be toxic to the kidneys, hence accelerating the progression to ESRD.
Awareness and knowledge about a disease will generally correlate with health-seeking behavior and enhance the chances for early detection. When CKD is undiagnosed or undetected, the healthcare system loses the opportunity to improve outcomes.
How is ESRD treated in Nigeria?
When CKD progresses to stage 5 (ESRD), which means the patient has 1015% or less of the kidneys working, medication and dietary adjustments are not enough. To stay alive, the patient will need to receive one of the following treatments:
a) Hemodialysis Artificial filtering of the blood by a machine to replace the work that damaged kidneys can’t do. Hemodialysis is the most readily available form of treatment for ESRD in Nigeria.
b) Peritoneal dialysis Through a catheter, a special fluid is placed in the abdomen, allowing the body to filter the blood using the natural membrane lining the abdomen. Peritoneal dialysis is not widely available in Nigeria.
c) Kidney transplant Kidney transplantation is performed infrequently in a few tertiary hospitals in Nigeria and it is obviously very expensive.
What is the cost of treatment of ESRD in Nigeria?
Hemodialysis is the most commonly applied form of treatment for ESRD in Nigeria. By convention, patients receive hemodialysis for about 3 to 4 hours, three times a week.
Hemodialysis treatment is very expensive. In many countries, the government pays for hemodialysis treatment or kidney transplants, with patients bearing little or no out-of-pocket cost.
By contrast, in Nigeria, patients with ESRD who require hemodialysis or kidney transplant must bear the entire cost. The cost of a session of hemodialysis treatment in Nigeria ranges from N25,000 to N35,000. Consequently, most patients cannot afford to be hemodialyzed three times a week for long. In fact, surveys show that most patients are only able to pay for a few sessions of hemodialysis - they discontinue hemodialysis and go home “to die”.
Kidney transplant surgery in Nigeria costs between N5 million and N10 million, and this does not include the cost of very expensive immunosuppressive medications that the patient must take continuously after transplantation to avoid “rejection” of the transplanted kidney.
Prevention – The Smart Way to Go
To put it bluntly, the overwhelming majority of Nigerians who develop ESRD cannot afford hemodialysis or kidney transplantation and are typically dead within a few months. Thus, prevention – by any means necessary – should be the mantra.
In the next installment in this series, we will humbly prescribe a comprehensive action plan for kidney failure prevention in Nigeria where each one of us has a major role.