Kidney diseases need urgent attention

Saturday, August 30, 2008 (The Mirror Pg 15)
By Rebecca Kwei
A Nephrologist, Dr Charlotte Osafo, of the Renal Dialysis Unit of the Korle Bu Teaching Hospital, has described the number of Ghanaians suffering from kidney diseases as a serious problem that need urgent attention.
She said although there were no statistics on the general population on kidney diseases, 9.5 per cent of admissions to the medical block of the hospital were due to renal or kidney diseases.
Additionally, Dr Osafo indicated that a research she conducted last year where she screened 770 hypertensive patients in the four polyclinics in Accra showed that 42.9 per cent of the patients had chronic kidney disease while 12.6 per cent had moderate to severe kidney disease.
Also, she said approximately she sew five to 10 new cases of chronic kidney disease at the hospital every week.
What was worrying, she said, was that the patients did not know they had the disease and it was evident that they would only report to the clinic when the situation had deteriorated or at its end stage.
The kidney performs very important functions in the body such as maintaining fluid and electrolyte balance (thus controlling blood pressure), acid base balance, filtering the blood, getting rid of metabolic waste and other toxic products. In addition, the kidney produces several chemical messengers, one of which is erythropoietin, which controls red blood cell production in the bone marrow. According to Dr Osafo, because of its important role, when there is renal failure or kidney failure, a situation where the kidneys fail to function adequately, there was a big problem and it could be fatal.
She said kidney failure could be acute, which was reversible, and chronic, which was irreversible.
Some of the causes of chronic kidney failure are uncontrolled hypertension, poorly controlled diabetes, infections and use of some drugs.
Dr Osafo said kidney disease presented no symptoms but in very advanced cases of kidney failure patients experienced chronic fatigue, weakness, vomiting, nausea, swelling around the eyes and feet and significant reduction in the amount of urine passed in a day.
She said chronic kidney disease was assessed using the Kidney Disease Outcome Quality Initiative (KDOQI) guideline, which has five stages. Stages one and two are mild, stages three and four are moderate and stage five is severe.
She explained that if a patient is within the range of stages one to four, the disease can be managed by aggressive blood pressure (in the case of hypertension) and sugar control (in the case of Diabetes), in order to prevent progression to end-stage kidney disease or kidney failure, which is stage five.
However, if the patient has advanced to stage five, then, the patient will have to be put on haemodialysis or peritoneal dialysis while the patient prepares for the ultimate treatment for the end-stage kidney disease, which is kidney transplantation.
She said dialysis did some of the work of kidney but not all. “Dialysis only performs the excretory function of the kidney as it only manages the waste accumulated in the blood.”
The patient with kidney failure therefore will have to buy the erythropoietin injection, which costs about GH¢100 a week in addition to the haemodialysis.
Dr Osafo noted that it was very expensive for patients to be on dialysis, since it cost 100 euros per session and a patient would have to undergo the treatment three times a week.
She, therefore, advocated that treatment of chronic kidney failure should be included in the National Health Insurance Scheme (NHIS), since patients could not afford it and would eventually lose their lives.
To buttress her point, she said “the total kidney cases that were admitted to medical block of the hospital from 2006 to date was 558 and only 38 out of that number were on dialysis. This shows how serious the problem is. This is only the tip of the iceberg because you can imagine the others that are not reported from the other parts of the hospital including the outpatients department, the Surgical Medical Emergency, the Cardiothoracic Centre and the many other departments in the hospital.”
Dr Osafo advised that people who were hypertensive decrease their salt intake, take their medication seriously and control their blood pressure while diabetics should try and control their sugar level.
Above all she encouraged healthy living, healthy eating and regular exercise and cautioned people to avoid drugs or herbs that they did not know their side effects.
She appealed to the public to support the National Kidney Foundation that had been established to create awareness about the disease and screen people for kidney disease.
In a related development, Ecobank Ghana last week presented $20,000 to Transplant Links, a UK charity that has the primary objective of saving lives through kidney transplants in the developing world.
Members of the charity, who will partner their counterparts in Korle Bu, will in November this year carry out kidney transplant for three Ghanaian patients, the first-ever in the country.