Renal failure in Nigerian children: factors limiting access to dialysis

A 5-year clinical and laboratory study of Nigerian children with renal failure (RF) was performed to determine the factors that limited their access to dialysis treatment and what could be done to improve access. There were 48 boys and 33 girls (aged 20 days to 15 years). Of 81 RF patients, 55 were eligible for dialysis; 33 indicated ability to afford dialysis, but only 6 were dialyzed, thus giving a dialysis access rate of 10.90% (6/55). Ability to bear dialysis cost/dialysis accessibility ratio was 5.5:1 (33/6). Factors that limited access to dialysis treatment in our patients included financial restrictions from parents (33%), no parental consent for dialysis (6%), lack or failure of dialysis equipment (45%), shortage of dialysis personnel (6%), reluctance of renal staff to dialyze (6%), and late presentation in hospital (4%). More deaths were recorded among undialyzed than dialyzed patients (P<0.01); similarly, undialyzed patients had more deaths compared with RF patients who required no dialysis (P<0.025). Since most of our patients could not be dialyzed owing to a range of factors, preventive nephrology is advocated to reduce the morbidity and mortality from RF due to preventable diseases.