Future Options for the Management of Chronic Kidney Disease in Nigeria

doi:10.1016/j.genm.2011.10.002

Gender Medicine

Volume 9, Issue 1, Supplement, February 2012, Pages S86-S93

https://doi.org/10.1016/j.genm.2011.10.002 Get rights and content

Abstract

The lack of health care infrastructure and prevalence of infectious disease in Nigeria exacerbate the growing problem of diagnosing and treating chronic kidney disease. Nigeria should place more emphasis on chronic kidney disease education, screening, and prevention; propagation of acceptance of peritoneal dialysis over hemodialysis; subsidization of renal replacement costs; and advancement of the national renal transplantation program.

Introduction

Chronic kidney disease (CKD) is a global public health problem estimated to have an annual growth of about 6% to 8%, although regional differences occur.1, 2, 3, 4, 5 The global burden of this disease is often underestimated. Countries in sub-Saharan Africa are faced with high prevalence and incidence rates of CKD that progress to end stage renal disease (ESRD) requiring renal replacement therapy (RRT).1, 2 There is no established CKD registry in Nigeria and thus available data are often estimates. One estimate extrapolated 12,000 new cases of ESRD annually with an ESRD prevalence of 120,000 patients in Nigeria.³ Only 750 patients are receiving regular hemodialysis in Nigeria.³ All forms of RRT are very expensive, require trained medical personnel, and often cannot be performed without advanced technological medical equipment. These resources are very scarce in developing nations such as Nigeria.

Section snippets

Etiology of CKD in Nigeria

The three leading causes of CKD in Nigeria are chronic glomerulonephritis, hypertension, and diabetes mellitus.3, 4, 5 Alebiosu et al,⁶ in their study on the pattern of chronic renal failure in Nigeria, found chronic glomerulonephritis to be a cause of ESRD in Nigeria in 41.2% of cases, followed by hypertensive nephrosclerosis (26.1%) and diabetes mellitus (13%). Although chronic glomerulonephritis may be a more common cause of CKD in Nigeria, diabetes and hypertension are the most common

CKD: A Public Health Problem in Nigeria

Efforts to control malaria, diarrheal illnesses, and HIV/AIDS have been underway in Nigeria for some time. However, rates of chronic diseases like cardiovascular disease, diabetes, and hypertension have been on the rise.⁸ Adding the burden of another chronic disease such as CKD will stretch the limited health care resources in the country beyond its limits. Some estimates place the incidence of ESRD as high as 1000 per million,³ possibly with more at various stages of CKD. The lack of health

RRT in Nigeria

Various options for RRT exist in Nigeria. Hemodialysis has been available in Nigeria since 1981¹ and still remains the predominant option for RRT. In 2006, there were just >50 hemodialysis units in the country with <1% of the population with ESRD receiving regular hemodialysis.³ Of the 120,000 patients with ESRD in Nigeria, only ∼750 receive dialysis, with the remainder being untreated.

Renal transplantation in Nigeria became an option in 2000 when the first kidney transplant was successfully

The Case for Peritoneal Dialysis

Peritoneal dialysis (PD) has not been popular as a choice of renal replacement in Nigeria; very few patients with ESRD receive PD as opposed to 11% worldwide³ and 8% in the United States.²¹ PD may be a more appropriate option for RRT in a country like Nigeria because it could to be less expensive and requires less technology to carry out.

The dialysate fluid used in PD in Nigeria is imported and, because the use of PD is not widespread in the country, the unit cost of dialysate fluid is

The Potential for a PD Program in Nigeria

Increased access to PD is long overdue in Nigeria. Funding and organization of any large-scale program must come from the federal government and Ministry of Health. The creation of a CKD registry is a feasible first step toward a systematized approach to treatment, and could guide the allocation of very scarce resources.

The current situation—where PD costs more than in-clinic hemodialysis—is largely due to the cost of imported dialysate, which is a correctable problem. The PD solutions should

Prevention and Effective Treatment in Nigeria

With CKD reaching endemic levels in Nigeria, there is an urgent need to tackle the increasing incidence of chronic renal disease in Nigeria. The optimal approach to the issue of CKD in Nigeria entails addressing the problem at the level of disease prevention. The primary aim should be preventing the onset of kidney disease (ie, primary prevention).²⁷ Individuals should be educated on risk factors and causes of CKD. The government has embarked on malaria eradication campaigns, HIV prevention

Conclusions

With Nigeria on the brink of a chronic disease crisis (ie, increasing rates of diabetes mellitus, hypertension, cardiovascular disease, and CKD), there is need for the concerted effort of all stakeholders to work together. The etiology of CKD encompasses chronic diseases and communicable diseases that have plagued the country and all of sub-Saharan Africa for decades. Diabetes, hypertension, and infectious conditions such as malaria and HIV are all implicated in the etiology of CKD, whereas

Conflicts of Interest

The symposium and publication of these proceedings were supported by: The National Institutes of Health, The Drexel University College of Medicine, The Helen I. Moorehead, MD Foundation, The Doris Willig, MD Foundation, The Institute for Women’s Health and Leadership, and The Center for Women’s Health Research at the Drexel University College of Medicine.

Acknowledgments

The authors would like to thank Brian T. Crain (Drexel University College of Medicine) for his assistance in revising the manuscript. Both authors contributed equally to the conduct of the study and creation of the manuscript.

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The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.
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Citation Excerpt :
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Family caregivers in many African countries bear the burden of caregiving alone, with the paucity of research, especially for caregivers of End-Stage Renal Disease patients, having concealed their needs.
To explore the caregiver burden of family caregivers of End-Stage Renal Disease (ESRD) patients in South-West Nigeria.
Following a complementary mixed method data collection strategy, the quantitative data was collected using the Zarit Burden Interview questionnaire to measure the burden of caregiving. Qualitative data was thereafter obtained through in-depth, individual interviews and was analysed using content analysis.
The three research settings consisted of two state hospitals and one private hospital that provide renal care in South-West Nigeria.
The mean burden of caregiving for the sample was 50.18 thus indicating that family caregivers experienced moderate to severe burden, which is high compared to the other studies. The participants’ experiences of caregiving revealed the following categories: total dependence, acceptance of caregiving role, competing responsibilities, financial sacrifice and “not making mistakes”.
Understanding the extent of caregiver burden, what constitutes burden to family caregivers in low/middle-income countries, and the difficulties associated with caregiving for care-recipients with ESRD, allows appropriate strategies and interventions to be developed.
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CommentaryFuture Options for the Management of Chronic Kidney Disease in Nigeria

Abstract

Introduction

Section snippets

Etiology of CKD in Nigeria

CKD: A Public Health Problem in Nigeria

RRT in Nigeria

The Case for Peritoneal Dialysis

The Potential for a PD Program in Nigeria

Prevention and Effective Treatment in Nigeria

Conclusions

Conflicts of Interest

Acknowledgments

Kidney Int

Gynecol Oncol

Am J Hypertens

End-stage kidney disease in sub-Saharan Africa

Ethn Dis

End stage kidney disease in Nigeria; the magnitude of the problem

Predisposing conditions, management and prevention of chronic kidney disease

The global burden of chronic kidney disease and the way forward

Ethn Dis

Chronic renal failure at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Afr Health Sci

Chronic kidney disease: a new priority for primary care

Br J Gen Pract

Is renal replacement therapy for all possible in developing countries?

Ethn Dis

HIV and AIDS estimates

Prevalence, detection, management, and control of hypertension in Ashanti, West Africa

Hypertension

Prevalence of adult diabetes in Ibadan, Nigeria

East Afr Med J

Genetic epidemiology of hypertension: an update on the African diaspora

Ethn Dis

Commentary
Future Options for the Management of Chronic Kidney Disease in Nigeria