Chronic kidney disease (CKD) is a progressive disease that increases the risk of hospitalization and death in sufferers. These risks can be reduced and their condition well managed by dialysis.
It is estimated that about 10 million Nigerians have CKD, with about 25,000 progressing to end stage kidney disease yearly and requiring renal replacement therapy in the form of dialysis or renal transplantation. Local data, as reported by the Nigerian Observer, estimates that about 9000 inhabitants of Edo State have CKD with 300 of them on maintenance hemodialysis. Of these 300, about 60% have no access to dialysis or cannot afford the cost, which is why the ENAW is initiating this lifesaving treatment.
The genetic makeup, and environmental factors like the indiscriminate use of herbal remedies, poor nutrition and infections put the people of African descent at increased risk of developing kidney disease. Common causes of CKD worldwide and in Nigeria include- diabetes mellitus, hypertension, chronic kidney infections and human immunodeficiency virus (HIV) associated kidney disease.
The common complications of CKD include- fluid accumulation and build up of toxins in blood (uremia), anemia, malnutrition, heart failure, deterioration of bone health, depression and decreased quality of life. However, for optimal functioning, it is required that patients with CKD should have 3 sessions of hemodialysis weekly as it is obtainable in developed countries. The average Nigerian with end stage kidney disease has a dialysis session weekly owing to inadequate funds and limited number of centers offering dialysis services. In Nigeria other forms of renal replacement therapy (peritoneal dialysis and kidney transplantation) are still underutilized leaving hemodialysis as the major option relied on for sustenance. In Nigeria, the use of peritoneal dialysis is limited by unavailability of peritoneal dialysis fluids and increased risk of infection while kidney transplantation is generally unaffordable as it cost about 15million naira to have the procedure in Nigeria.
All patients with CKD on dialysis are expected to pay for their care, as there is little or no assistance from the federal or state government despite years of advocacy by the Nigerian Association of Nephrology and other pressure groups.
In Edo State, Nigeria, there are only 5 centers offering hemodialysis, all of which are located in urban areas (Benin- City and Irrua). Sadly, these centers do not currently offer services to “infected cases” (patients with HIV, hepatitis B and C viral infection), requiring them to travel to neighboring states for dialysis. This poses an increased risk of threat to life, and deaths related to kidney failure, road traffic accidents, and security challenges. Also, 2 of the 5 existing dialysis centers offer services only during the day, not minding the fact that complications can arise at any time of the day requiring lifesaving emergency dialysis. At the University of Benin Teaching Hospital (UBTH), there are an average of 2 deaths of patients on maintenance hemodialysis per month.