An estimated 20 million Nigerians are living with kidney disease. A good number of these patients are languishing under the huge cost of treatment and medication and a shortage of medical equipment, as Daily Trust Saturday finds out.
Sixty-year-old Mariya Abdallah was diagnosed with end-stage kidney failure in 2018 and has been undergoing dialysis three times a week at the Ahmadu Bello University Teaching (ABU) Hospital, Zaria.
Every week, the mother of three has to fork out almost N80, 000 for treatment and for the last three years, she has been on a diet, she said.
“My older sister died from the same disease in 2014,” she said. “I started experiencing symptoms of nausea, I lost my appetite and I lost a lot of weight. We went to a private hospital and I was given medication but I didn’t get better. My oldest son took me to Abuja where I underwent a lot of tests and I was diagnosed with kidney disease,” she said.
Alhaji Bashir Musan Sati, a resident of Jos, Plateau State, underwent a kidney transplant in 2016. He said though he has been feeling better, it has been difficult accessing his kidney medications because the drugs are usually expensive and often unavailable in the country.
“When the drugs are not available, suppliers would have to order from India and it takes a lot of time to get to Nigeria because of customs delay or sometimes, it may be denied access into the country. In such situations, if you don’t have any alternative, you will definitely suffer,” he said.
“Sometimes the prescribed drugs have side effects like rashes, so I would have to complain to the doctor to change the prescription,” he added.
Every month he spends about N 100, 000 on medications and has routine appointments with his doctor to observe how his transplanted kidney is doing.
Dr Istifanus Bala Bosan, a Nephrologist with the ABU Teaching Hospital, Zaria said Nigerians are increasingly becoming more aware of the disease because services are becoming available. However, establishing a kidney treatment centre is very expensive.
“Even for the government, it is not easy to establish and when they are established, even the consumables for treatment are not cheap and so truly, access to treatment for established kidney disease is very expensive, only a few people can afford it,” he said.
The doctor said the cost of dialysis for those with end-stage chronic kidney disease (CKD), without the cost of consumables, is N20, 000 per session and for these patients to stay alive, they need three sessions per week.
“So, you can imagine spending between N60, 000 to N100, 000 every week for the rest of your life. Whether it is hemodialysis, where the impurities are removed through the bloodstream or peritoneal dialysis through the abdomen, all of them are expensive and they come to the region of requiring about N3million to N4million per person in a year,” he said.
Dr Bosan, however, said in the last few years, a lot of centres have been established with over a 100 across the country and advised that the cheapest way to avoid dialysis is to get screened for the disease.
“When diagnosed early, there are steps to be taken to prevent getting to the end-stage. Unfortunately, it does not come with symptoms; it is a silent disease and unless one is screened, you would never know that the person has the disease until it is too late,” he said.
The nephrologist said that when detected early, patients could be put on medication or lifestyle modification that can improve the functions of their kidney and stop further damage, adding that “even where the damage has gone too far and cannot be stopped, it can be slowed down in such a way that it takes a long time before one requires any replacement.”
For those who have reached the end-stage and are unable to access dialysis, he said: “Before dialysis service is available, virtually they all die within a matter of weeks and so it is also the same that if they are not picked up early, the chances are that they would die within a short period.”
I spent N4.5m on kidney transplant-Patient
A kidney patient in Kano, Shamsudeen Garba Moriki, who underwent transplant at the Aminu Kano Teaching Hospital (AKTH), said it has been challenging for him since he was diagnosed with the disease.
He first developed asthmatic and typhoid symptoms and was treated at the AKTH in 2016.
“When I realized that I wasn’t recovering, I then went to the doctor and he recommended tests for me and the results showed that my kidney has been affected; then, it was Acute Kidney Disease. They referred me to a speciality clinic and they put me on treatment,” he said.
But a strike action by doctors at the time meant that he could not receive the needed attention which made his kidney problem move from acute to chronic, requiring the expensive dialysis.
“That one-month strike by doctors is what caused the damage to my kidney. When I went back, it was discovered that my bilateral kidney is not working after undergoing a urinalysis test. That also forced me to start undergoing dialysis,” he said.
Since then, Shamsuddeen has been battling the disease and struggling with the finances for the medication and treatment.
“My first dialysis cost me N47, 000 and from then, I used to spend N10, 000 for each dialysis if the dialyzer and catheter are still working. But if the catheter gets spoilt, you will have infections. Also, this dialysis has to be done at least three times a week, costing almost N200, 000 in a month. And because I have blood pressure, I also have to spend much on that. So also, there are other medications that are very expensive aside from the dialysis.
“One also has to spend so much on tablets that helps your kidney in pumping blood and you need that also. You will also be taking injections which cost about N6, 000 and that will be twice a week. Another alternative is blood transfusion; like me, I have received over 20 pints of blood,” he said.
For Shamsudeen, respite came when he had a kidney transplant at AKTH. That did not come cheap as it cost him N4.5 million. But it was not Uhuru for him as he is now spending money on medications that will suppress his immunity, ensuring that his body does not reject the new kidney. When that happens, and experts say that could happen without warning, the kidney would fail and that would mean death for the patient.
“People will think that kidney problem will be over after transplant, but that’s where another battle began for me. After spending N4.5 million on the transplant, which we spent at least one-and-half year waiting for after booking, we also had to continue spending to ensure that the kidney is not infected again.
“The transplant is very good and I really enjoyed it because you will no longer do dialysis, you will not buy kidney infection medicines anymore, but you will buy other medicines. Roughly now, I spend about N100, 000 in a month despite the transplant and as you can see, I am financially incapable,” he said.
Shamsudeen appealed to the government and wealthy individuals to intervene and support people with kidney diseases.
A medical doctor with Rogo Local Government General Hospital, Dr Hassan Muhammad said dialysis is the most expensive of all kidney treatment and very necessary at the chronic stages of the disease.
He added that kidney disease has become rampant due to negligence of health protocols by people, especially the urinary issue.
“People should always report to hospitals whenever they feel any abnormality in their urine passage. They should also ensure they avoid self-medication, which leads to so many diseases. Drinking much water will also help a lot,” he said.
Fifty-year-old Mrs Akhare O. Flora said she has been battling kidney problems for over two years now.
Before she came down with this condition, she was a civil servant at Ikpoba Okha Local Government Area of Edo State. Since 2017, she has been unable to go to work because of the disease.
The single mother does dialysis twice weekly at N43,000 per session at the Kidney Solution and Dialysis Center, Ikeja, Lagos. And has been on dialysis since May 2018 and has been living with her son since.
Her condition, she said, has been very bad because her dialysis has not been regular due to financial constraints.
“I was told by the doctor to budget about N12 million for a kidney transplant. I also do dialysis twice weekly instead of three times a week as recommended by the doctor at Lagos State University Teaching Hospital. If I don’t go for dialysis on time, I get tired; my body and stomach also get swollen,” she said, weeping.
The major challenge according to her is lack of funds for her treatment.
“I have a donor already but no money for the operation. At Kidney Solution and Dialysis Center, Ikeja, where I do my dialysis, they have enough machines but it’s too expensive,” she said.
We’re seeing more patients with kidney disease— Nephrologist
A consultant nephrologist at the Benue State University Teaching Hospital (BSUTH), Dr Monday Ogiator told Daily Trust Saturday that the hospital has been receiving rising cases of kidney disease.
Ogiator though did not mention how many patients were been seen on a regular or daily basis at the facility.
“They are mostly patients in the third, fourth and fifth decades, mostly young patients,” he said.
The nephrologist further noted that funding is the major challenge in the management of the disease, stressing that most patients pay out of pocket and as a result, they find it difficult to fund their treatment.
For instance, most patients with end-stage renal disease cannot afford even two sessions of dialysis weekly.
“A lot of them cannot procure important medications like erythropoietin and iron sucrose,” he said. “Another problem is accessibility. The renal centres in the state are situated in Makurdi, the state capital, thus, making it difficult for patients living in remote areas to access renal care.”
Ogiator pointed out one other big problem was that most patients present very late when the disease has reached advanced stage thus leading to complications.
“Prevention of kidney disease is the right way to go. It is easier and cheaper to manage kidney disease in the early stages”, he said.
He urged the government to increase budgetary allocation to health as well as improve advocacy and formulate health policies that will take care of renal patients and expand the scope of health insurance to cater for renal patients including patients with end-stage renal disease.
Experts advocate kidney care policies in Nigeria
Meanwhile, experts have stressed the need for free or subsidized treatment of kidney disease to reduce the rising cases of the disease in the country.
The Head, Department of Medicine and a consultant nephrologist at the Wuse District Hospital, Abuja, Dr Kwaifa Ibrahim said, globally, there are over 700 million people suffering from chronic kidney disease.
He said it is called chronic kidney disease when it lasts more than three months and leads to kidney failure or end-stage renal failure.
Dr Kwaifa said the global average is 10 per cent and Sub Saharan Africa’s estimated kidney disease is placed at 13.1 per cent.
“If we take an average of 10 per cent and Nigeria with an estimated population of 200 million, the cases will be about 20 million people in Nigeria that are estimated to have chronic kidney disease.
But what causes the disease?
“If you are looking at different age groups that have different cause, then, diabetes is the number three causes of kidney disease. In males, we have prostate enlargement or bladder outlet obstruction; this is another cause of chronic kidney disease.
We also have sickle cell disease. There is also a condition inherently from the family called polycystic kidney disease and also infections that causes chronic kidney disease like HIV infection. Chronic hepatitis B infection and Hepatitis C all cause chronic kidney disease. Another one coming up is chronic kidney disease of unknown causes,” he said.
The consultant said there are other factors such as dehydration and usage of pesticide and other chemicals in farming.
Nigeria has more than 180 dialysis centres across the country, the consultant said. Those are not nearly enough, as there are congestions at all the centres.
“There are some patients that have money and are ill but they cannot be placed and again, the cost of dialysis is very high. For instance, in government hospitals, they charge between N22, 000 to N26, 000 for one session of hemodialysis for those that are registered with them. There are hospitals in Abuja that charge up to N50,000 per session.
“The treatment that has reached the chronic stage can either be done by hemodialysis, or a kidney transplant. We call them kidney replacement therapy but they are highly expensive. In private hospitals, it is close to N8.4 million in Nigeria. The one at government hospitals for instance, in Kano, costs N3.5 million and after transplanting, the patients need to be buying drugs to maintain the system for the kidney to blend. There is no kidney care policy from the government so, everybody bears their own burden of the diseases,” he said.
The existence of a kidney care policy is prevalent across the world, the doctor said, and it covers transplant and cost of treatment.
“But the way we are now in Nigeria, the National Health Insurance Scheme (NHIS) does not cover dialysis fully but for only six sessions. So, if a patient is there for dialysis twice a week, it can only last for a month. But the world over, dialysis is covered by the NHS so that one just pays a small premium and enjoys the service and that is the way forward.
“Countries like South Africa and the Gulf countries; the government pays everything and provides drugs free for their citizens. People who need dialysis just go and register and access it while those that need transplants and have donors, the government will pay for the cost of everything.
“I know some patients that transplanted but there’s no money to buy drugs to support their transplant. So, it’s a big issue and in as much as there is no support from the NHIS to take care of patients with dialysis, hypertension and diabetes, we will continue to have increasing numbers of patients. Unless the whole health system is overhauled in Nigeria, there will be a problem,” he said.
Unless that overhaul happens, for the estimated 20 million Nigerians with kidney disease, the torture and worry will continue. As will the deaths.