Poor lifestyle, cost of care expose 27m to renal ailments, death | The Guardian Nigeria News – Nigeria and World News

• 272,400 die of kidney diseases yearly
• Dialysis patient requires N160,000 weekly, N500,000 drugs monthly, N16m for transplant
• Practitioners bemoan organ harvesting, commercialisation

Growing patronage of poor lifestyle habits and other abuses are exposing more than 27 million Nigerians to chronic renal diseases, kidney failure, and deaths.

Besides the high-risk environment, the galloping cost of renal care has pushed remedial efforts beyond most sick Nigerians. Already, there are about 272,400 kidney-related deaths every 12 months.

In commemorating the World Kidney Day 2024 today, care practitioners have again highlighted the need for education about the importance of kidney health, healthy lifestyle, and urgency of collective support for the sick.

Of particular concern for stakeholders is the frequency of illicit drug, alcohol abuse, and organ harvesting, especially due to worsening poverty in the country.

According to the Nigerian Association of Nephrologist, out of the 12 per cent (that is, 27.24 million) of the Nigerian population who have Chronic Kidney Disease (CKD), one per cent of them (272,400) have severe form of the disease, which is the stage 4 and 5. Because they cannot afford the cost of dialysis, more than 90 per cent of them (245,160) die within the year.

Findings show different layers of care. For instance, a patient on dialysis needs an average of N160,000 weekly, for three dialysis sessions. Monthly, the cost ranges between N400,000 and N600,000, depending on the hospital of choice.

The cost of drugs is pegged at N500,000 per month, while dialysis is at an average of N16 million.

President of the Nigerian Association of Nephrologists, Prof. Jacob Awobusuyi, affirmed that between 10-12 per cent of Nigerians have chronic kidney disease (CKD).

Awobusuyi lamented that the growing number of citizens living with kidney disease is very worrisome not only for kidney specialists but to every individual who has encountered people with kidney disease.

He explained that there are five stages of CKD and most people are in the early stage and don’t have symptoms.

According to him, out of the number of Nigerians with CKD, one per cent of them have severe form which is stage 4 and 5 and because they cannot afford the cost of dialysis, more than 90 per cent of them die within the year also because they cannot afford the cost of dialysis.

He said: “I am worried because of the expensive nature of treating those requiring kidney replacement therapy and many catastrophic spending that they engage in. Many of my patients have sold all their belongings just to have treatment and a lot of them became impoverished because of the treatment.”   

The Nephrologist added that the factors that predispose people to kidney disease, such as diabetes, obesity, and hypertension, are on the increase in the communities because of poor diet. Many people are getting hypertensive as a result of eating food that contains a lot of salt, many people are getting obsessed and there is a lot of sedentary work while many are obsessed.

“We are recording an increase in kidney disease because hypertension and diabetes are becoming more prevalent in the communities and our diagnostic evaluation of individuals has improved. Apart from that, quite a few patients are young,” he added.

Awobusuyi urged the federal government to include kidney care in the health insurance to make treatment affordable and accessible to all Nigerians.

Globally, about 850 million people are estimated to be battling kidney diseases while more than five million people die yearly from lack of access to critical treatments for kidney disease.

By 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide.

Kidney disease is the leading global cause of catastrophic health expenditure because of the high costs of kidney replacement therapy.

Experts are unanimous that several factors can increase the risk of kidney damage, and with each additional factor, the risk of acute urinary system failure increases.

Risk factors include underlying renal insufficiency, intravascular volume depletion (sometimes seen in people on strong diuretics, as well as those with poor oral fluid intake, gastroenteritis, or chronic diarrhea), diabetes, heart failure, being 60 years of age or older, exposure to multiple nephrotoxins.

Various types of drugs have the potential to be nephrotoxic. Alcohol and other substances—including cocaine, opioids, 4-methylenedioxymethamphetamine (a.k.a MDMA or ecstasy)—can have direct and/or indirect physiological effects that can negatively impact kidney functioning.

In line with the theme for 2024 World Kidney Day, ‘Advancing equitable access to care and optimal medication practice’ stakeholders have called for measures in overcoming barriers at multiple levels while considering contextual differences across world regions.

These include gaps in early diagnosis, lack of universal healthcare or insurance coverage, low awareness among healthcare workers, and challenges to medication cost and accessibility. A multi-pronged strategy is required to save kidneys, hearts, and lives.

Globally, patients struggle to access care and medication due to high costs and misinformation, which impact their health behaviours and adherence.

Raising awareness about CKD risk factors such as diabetes, hypertension, and obesity, enhancing health literacy about healthy lifestyle choices, self-care, and promoting long-term adherence to treatment strategies can bring large benefits especially when initiated early and consistently maintained. Involving patients in advocacy organisations and local communities will empower them to make informed decisions and improve their health outcomes.

Similarly, health practitioners have expressed worry over the growing cases of organ harvesting and commercialisation of kidney in the country.

Director General of Nigerian Institute for Medical Research (NIMR), Prof. Babatunde Salako, noted that commercial kidney donors had been in existence for many decades globally, and fueled mainly by poverty and the get rich quickly syndrome that drives the interest of young men to donate their kidneys for the rich patients.

“Most nations’ transplant associations frown at commercialisation of organ donation. But the need for the sick rich patients to want to live and the poor to want to live well have continued to perpetrate this unwholesome practice,” he said.

Salako pointed out that there are issues of human rights concerning whether someone can do what he or she likes with his or her body and so most nations have come up with legislations against the practice driving practitioners underground, but it keeps thriving globally.

On what can be done to mitigate trafficking in persons for organ removal, Salako said, “I believe what needs to be done includes starting a cadaver donor programme in Nigeria to reduce the scarcity of organs for transplantation.

“Government should ensure the enforcement of the law to make some people a deterrent for others. Provision of job opportunities for young people in Nigeria. Transplant practitioners should ensure that living donors should be altruistic in all ramifications. Government can also take over the needs and health concerns of the living donors to reduce the cost to the donors,” he said .

Organ trafficking has continued to be an issue of global concern as the current global need for organs is far higher than the supply leading to a continuous drive in Organ demand and transplant.

According to the Global Observatory on Donation and Transplantation, 2020, more than 150,000 transplants are performed yearly worldwide. However, this is less than 10 per cent of the global need.

The 2008 Istanbul declaration on Organ Trafficking and Tourism, which Nigeria is a signatory to, prohibits organ commercialisation.

Despite this, the World Health Organisation reveals that more than one kidney is traded on the black market every hour.