Rising incidence of kidney disease in Kenya hurt the poor and dent development

The profound eyes, calm demeanour and hospitable nature of 13-year-old Yvonne Wangari easily draws her to people.

Amid strangers, she may apprehensively clench her fists only to loosen up seconds later once a rapport is established. This makes her smooth light-brown skin glow wondrously.

When we caught up with her in Nairobi’s Pumwani estate, where she lives in a three-roomed apartment with her mother and few relatives, she emerged from one of the quarters adorned in a flowing blue dress — with white dots — and a matching jacket.

After a brief handshake and exchange of niceties, Wangari picked a phone from a nearby table and seemed engrossed in it for a while.

“Have a look please,” she eagerly said with a radiant smile.

“These are my mum, brother, auntie and grandparents,” Wangari stated with affection glowing on her face as her fingers slid through a succession of photos saved on the touch screen phone.

Then she abruptly stood, appeared to have remembered something important, and headed straight to a cabinet where she removed numerous packets of medicine.

Wangari’s facial expression suddenly changed, she appeared pensive as she diligently selected about nine tablets from the assorted drugs and carefully swallowed them with water — one at a time.

It was the first indication that her seemingly perfect life has not always been rosy.

Wangari is a kidney disease survivor, one among thousands in the country. The ailment has robbed her of a normal childhood. Her mother, Margaret Muthoni, said that all was well until 2010 when she noticed that her once playful daughter was withdrawn and appeared weak.

“As other children played, she would prefer to sit and watch from a distance instead of joining the action,” said Muthoni.

READ: Kidney disease among top killers in Kenya

Gradually, Wangari became bow-legged. However, doctors mistakenly thought that she was suffering from rickets and recommended calcium and vitamin D supplements which failed to rectify the problem.

In 2012, after two years of pain, Wangari was diagnosed with a kidney disease. By then it was too late as the organs were no longer functioning.

She was immediately put on dialysis, a process that uses a special machine to clean blood and rid it of toxins. This is a role usually played by healthy kidneys.

“Dialysis wasn’t a pleasant experience as I would feel weak and have headaches for about a day,” remembered Wangari.

Luckily, she underwent a kidney transplant last year after an uncle donated one of his kidneys to her. After the successful surgery, Wangari is no longer in need of dialysis sessions any more.

Nevertheless, she has been put on medication for life to prevent her body from rejecting the new kidney. The drugs cost about Sh30,000 monthly — money that Ms Muthoni said was hard to come by.

That withstanding, Wangari is thrilled that she can now play, cook and participate fully in school. Cases of kidney disease are rising in Kenya with about 8,000 new cases reported annually, according to Kenya Renal Association statistics.

Figures from the association also show that one in every 10 Kenyans has some form of kidney disease. This translates to about four million people.

Patients

Out of these, about 10,000 lose their lives yearly and never live to tell their story as little Wangari. Doctors attribute the deaths to late diagnosis leading to delayed treatment and care.

Dr Anthony Were, the head of the Kenyatta National Hospital (KNH) Renal Unit, noted that kidney diseases pose a threat to national development as they often result in long term complications that are costly to treat.

Dr John Ngigi, a kidney specialist at KNH, said that if challenges to the management of the disease are ignored, it can adversely affect the economy since those affected are a significant proportion of Kenya’s workforce.

Lives of children like Wangari are equally important as they are future drivers of development.

According to Dr Ahmed Sokwala, a consultant physician and nephrologist at Aga Khan Hospital, the disease is of two types. Acute kidney disease occurs in very sick patients. This causes a sudden loss of kidney function.

In most cases, patients usually get well within a few days but urgent treatment, including dialysis, is needed as they await full recovery.

Chronic kidney disease (CKD), on the other hand, refers to the progressive loss of kidney function over a long period. Those at the highest risk of CKD are people with hypertension, diabetes, obesity and a family history of the disease.

Aging is also a risk factor. Studies have shown that after the age of 40, kidney function begins to fall by approximately one percent each year.

These conditions rapidly destroy millions of tiny filters in the kidney — called nephrons — which are responsible for removing dangerous waste from blood.

But this does not mean that younger people are safe, noted Dr Sokwala. CKD can affect anyone at any age, “that’s why getting check-ups yearly is important.”

Further, health economists estimate that if kidney disease is nipped in the bud during its formative stages, it can save a potential patient Sh4 million annually.

Dr Were warned that CKD is a silent killer as symptoms are often hidden during the initial stages of the disease.

By the time most people begin feeling unwell, he said, they are usually at the final stage of the disease — commonly referred to as kidney failure. The disease can therefore be a silent killer.

Causes of CKD in children differ from those in adults. They include hereditary conditions such as lupus and severe throat infections (causes by Streptococcus bacterium).

Dr Ngigi noted that birth defects also cause kidney disease in children. For instance, Wangari was born with a condition known as Reflux Nephropathy which causes urine in the bladder to flow to kidneys thus destroying them.

With early diagnosis and treatment, he said, such problems can be corrected early enough before they damage kidneys.

The Kenya Renal Association predicts that CKD cases are expected to increase by 17 per cent over the next decade, if not recognised as a global public health issue.

Prof Seth Mc’Ligeyo, chairman of the association, said that these are worrying trends since a considerable number of patients with CKD go on to develop kidney failure.

Expensive

If the patients fail to get treatment in the form of dialysis or transplants, they die.

“Yet these modalities of treatment are expensive and a burden to most Kenyans,” said Prof Mc’Ligeyo who lectures at the University of Nairobi and is also a kidney specialist.

He regretted that cases of kidney diseases are growing in the country yet resources channelled towards their management are minimal.

“We aren’t well placed to adequately take care of our patients,” he said.

Patients with kidney failure often require about two to three sessions of dialysis. Each costs about Sh5,000 in public hospitals and twice as much in private ones.

Moreover, dialysis procedures are conducted in only five major referral public hospitals in Kenya located in Nairobi, Mombasa, Kisumu, Nakuru and Eldoret. These few facilities cannot sufficiently meet the needs of sick patients scattered all over the country.

As such, many patients are forced to incur additional transport and lodging costs to reach the facilities. When medical staff at counties go on strike — as has been the case lately — the situation worsens since the few facilities that offer dialysis are closed.

KNH is the only public facility in Nairobi whose already congested Renal Unit — with just 15 dialysis machines — serves kidney patients from the entire city and its environs.

Upon entering the unit, one is poignantly exposed to gloomy faces, a sombre mood and distance gazes of patients connected to dialysis machines.

The red fluid flowing in and out of tubes attached to their bodies offers them a new lease to life, as the patients’ kidneys can no longer clean their blood.

“Most of our patients seem darker, weaker and sicker as they can only undergo dialysis once weekly due to limited machines,” said Janet Odhiambo, senior nursing officer at the Renal Unit as she tended to a young boy undergoing dialysis.

Ms Odhiambo cannot afford to give up. So she smiled and lightened up the atmosphere in the ward.

“Things will improve soon, once we get more machines,” said the nurse who has worked in that unit for years.

To adequately meet needs of ailing Kenyans, said Dr Were, all counties should have dialysis machines.

“We are now training medical staff across the country on this technology to facilitate this process,” he said. Dialysis usually offers a temporary solution to patients as they await kidney transplants.

Yet, transplants can be done by only eight doctors in Kenya. The surgical procedure costs Sh500,000 at KNH, the only public facility offering it, and about Sh1 million in private hospitals.

Dialysis

The National Hospital Insurance Fund (NHIF) subsidises transplant costs at KNH by paying Sh200,000 for patients.

Those undergoing dialysis also get a waiver of Sh2,000 in public hospitals. “But the remaining amount is still high for most Kenyans,” said Dr Ngigi.

There are only 23 kidney specialists in the country and only eight serve in the public health sector. “This is a gap that should be addressed urgently so we can have doctors spread out across the country,” said Dr Were.

Aside from relying solely on government funds to solve kidney management challenges, the public sector is now forging partnerships with the private sector.

For instance, KNH is collaborating with Novartis and Kenya Commercial Bank (KCB) in an initiative known as the ‘‘Inter-life Programme’’ which enables the hospital to perform kidney transplants at a reduced cost.

Wangari was a beneficiary of the scheme. “Without this arrangement, it would have been almost impossible to meet the transplant costs,” said Muthoni.

She added that high prices of immune suppressing drugs, used for life after the transplant, should also come down.

To prevent kidney disease, the World Health Organisation recommends an active lifestyle, controlling blood sugar levels, monitoring blood pressure, healthy eating, avoiding regular use of over the counter drugs and smoking.