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Low awareness, high costs add to Kenya’s kidney disease burden

When someone has chronic kidney disease it means their kidneys are unable to filter waste and excess fluids from blood. PHOTO | FILE
When someone has chronic kidney disease it means their kidneys are unable to filter waste and excess fluids from blood. PHOTO | FILE 

Every hour close to three patients go for a session of dialysis at the Kenyatta National Hospital (KNH), translating to at least 60 kidney patients a day.

The number of preauthorisation for treatment done by the National Hospital Insurance Fund (NHIF) for dialysis nationally in the four months to October has also been going up from 45 in July to 2,027 in October.

This means the prevalence of both acute and chronic kidney disease continue to escalate, implying an increase in the economic and social burden of the disease, according to a consultant physician and kidney specialist— also the Head of Renal Unit at KNH - Dr John Ngigi.

“Prevalence of the disease and worldwide use of renal replacement therapy (RRT) including dialysis are expected to rise sharply in the next decade,” said Dr Ngigi.

“Opening up of many dialysis centres and increasing uptake to insurance just improves on both financial and geographical accesses but does not affect disease prevalence or incidence… more needs to be done.”

A report by the Lancet shows that end-stage kidney disease —a chronic kidney disease — is a leading cause of morbidity and mortality worldwide and close to three million people suffering from chronic kidney failure across the world receive RRT every year.

But between 4.9 million and 9.7 million more still need treatment with at least two million people dying because they cannot access or afford it.

Kidneys are body organs that filter wastes and excess fluids from the blood, which are then emitted in the urine. When someone has chronic kidney disease it means their kidneys are unable to perform these tasks hence they require RRT in the form of dialysis or kidney transplant to replace the sick one(s).

Claims paid

The NHIF paid Sh5.9 billion in members’ medical bills in the four months to October with more than half of it going into surgeries (including kidney transplants) and another big chunk in dialysis payouts.

NHIF paid Sh84.2 million for dialysis bills, making it top of the claims list in just four months meaning more Kenyans are suffering from chronic kidney ailments.

This amount is characterized by a rising number of preauthorisation made for new kidney patients.

In July, for instance, the fund paid Sh894, 500 for 45 patients seeking dialysis with the number rising to 280 kidney patients in August for the same treatment which cost Sh3.92 million.

October cost NHIF the highest at Sh79.2 million in claims payout for 2,027 kidney patients who received dialysis.

“NHIF payout for a session of dialysis at KNH is Sh9, 500. A patient does at least two dialysis sessions in a week,” said Dr Ngigi.

“NHIF also pays Sh500, 000 for kidney transplant.”

He added: “Increasing prevalence of diseases of affluence like diabetes, hypertension and obesity have seen a parallel increase in kidney disease. The changing lifestyle is to blame in a majority of these cases.”

At least more than eight people out of 10,000 in the country are diagnosed with one form of kidney disease or another, according to Dr Ngigi.

The lack of awareness on signs and risks of kidney disease is also to blame as it leads to late presentations which when coupled with poor laboratory support results to poor diagnosis, he said.

“Simple tests like urinalysis, monitoring of one’s blood pressure and sugar level testing can identify likely problems and are recommended for screening at risk population,” said Dr Ngigi.

“Complications related to infections, hypertension and diabetes are the commonest causes of chronic kidney failure in our setting and in that order.”

Common symptoms

Underlying kidney disease is often asymptomatic and requires a high index of suspicion, Dr Ngigi said.

“We identify people (high risk population) who have diabetes, hypertension, have a family member with kidney disease, people living with HIV, obese, people on chronic drug use especially for various arthritis including gout to be at high risk of suffering chronic kidney disease,” said Dr Ngigi.

“Generally swelling of the body (especially morning facial puffiness and subsequently whole body swelling), anemia, difficulties in breathing, easy tiredness, bone pains and finally poor appetite and vomiting are some major signs and symptoms of underlying kidney disease.”

In cases of people living with HIV being at increased risks of kidney failure, Dr Ngigi said the infectious disease (HIV) can itself invade the kidney. Some antiretroviral drugs also affect the kidneys.

Complications like vomiting, diarrhea and resultant infections can directly cause kidney failure.

Obstruction to urine flow, autoimmune diseases like lupus, toxic nephropathies, cystic kidney diseases and complications related to pregnancy can also cause kidney ailments. Dr Ngigi said that currently they are seeing a trend where many acute kidney injuries with a few of which fuel chronic kidney disease.

“These are as expected to present in such situations and we can only prepare for infections, trauma and volume losses,” he said.

Sore throat and kidney disease

Also, the internal structure of the bacteria that causes sore throat shares some similarities to the lining of the internal structure of the kidney.

Upon infection of the throat in children and young adults the body produces antibodies which are meant to attack the bacterial antigens but unfortunately fails to select out the Kidney internal lining hence destroying it causing disease.

“This happens a few weeks after the sore throat and is often missed,” said Dr Ngigi.

In its acute presentation patients are swollen, develop hypertension and get into both kidney and sometimes heart failure.

The disease can self-remit but can also take a chronic cause only to present after many years as chronic glomerulonephritis causing kidney failure and end stage kidney disease.

The treatment of chronic kidney failure is a transplant and for those on dialysis should ask their providers to refer them to a nephrologist for assessment.

“Kidney transplantation is no longer a complicated science and is available locally,” he said.

“NHIF should start offering subsidy on post-transplant medications to increase uptake of kidney transplants and ensure long term graft survival.”

Dr Ngigi said awareness on signs and symptoms of kidney disease is as important as improving on the diagnosis and as well as improving on advocacy on screening and lifestyle changes.

KNH is currently operating 21 dialysis machines of which five were purchased and installed under the Sh38 billion medical equipment programme.

“We thought the five additional dialysis machine would lift the burden at KNH, unfortunately we are slowly getting overwhelmed like before contrary to our expectations given that many private dialysis centres have opened up and are duly NHIF accredited,” said Dr Ngigi.

The KNH Renal Unit offers three sessions of dialysis per machine daily.

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