Challenges of providing maintenance hemodialysis in a resource poor country: Experience from a single teaching hospital in Lagos, Southwest Nigeria

Abstract

Providing maintenance hemodialysis is associated with high costs and poor outcomes. In Nigeria, more than 90% of the population lives below the poverty line, and patients with end-stage renal disease (ESRD) pay out-of-pocket for maintenance hemodialysis. To highlight the challenges of providing maintenance hemodialysis for patients with ESRD in Nigeria, we reviewed records of all patients who joined the maintenance hemodialysis program of our dialysis unit over a 21-month period. Information regarding frequency of hemodialysis, types of vascular access for dialysis, mode of anemia treatment and frequency of blood transfusion received were retrieved. One hundred and twenty patients joined the maintenance hemodialysis program of our unit during the period under review. Seventy-two (60%) were males and the mean age of the study population was 47 + 14 years. The mean hemoglobin concentration at commencement of dialysis was 7.3 g/dL + 1.6 g/dL. The initial vascular access was femoral vein cannulation in all the patients. A total of 73.5% of the patients required blood transfusion at some point with 33% receiving five or more pints of blood. Only 3.3% of the patients had thrice weekly dialysis, 21.7% dialyzed twice weekly, 23.3% once weekly, 16.7% once in two weeks, 2.5% once in three weeks and 11.7% once monthly. At the time of review, 8.3% of the patients had died while 38.3% were lost to follow-up. Majority of patients with ESRD on maintenance hemodialysis in our unit were poorly prepared for dialysis, were under-dialyzed, and were frequently transfused with blood with resultant poor outcomes.

Challenges of haemodialysis: A single centre experience in South West Nigeria

“…Chronic glomerulonephritis as seen in 44.6% was the commonest aetiology cause of CKD among our patients. This is similar to the report of Oluyombo et al, and Okaka et al [6,7], but in contrast to the indings of Bello et al, who reported hypertension as the cause of CKD in about half of their patient population [8]. Majority of our patients with chronic kidney disease presented very late with established complications.…”

“…A high percentage (43.6%) of patients were lost to follow up during this period due to reasons which may not be unrelated to inancial constraints, traditional belief, and concept about the disease among others. A similar igure was reported by Meremo et al in Tanzania [16] and Bello et al in a Nigerian study [8]. Causes of death were inadequate dialysis due to inancial constraints with its attendant complications, poor compliance to medication including antihypertensive, and sepsis among others.…”

“…This grossly fell short of the recommended target as outlined by Kidney Disease Outcomes Quality Initiative (KDOQI) [15]. Similarly, an unacceptable low number of patients having inadequate frequency of dialysis was documented by other researchers [5,8,16]. Almost all our patients paid out of pocket without any inancial aids from the government hence they could not cope with the cost implication of dialysis.…”

The Need for Dialysis in Haiti: Dream or Reality

“…As the number of patients afflicted grows exponentially, the available resources become more and more limited. In addition, accurate and timely diagnosis, the cost of dialysis, the access to dialysis facilities and the number of trained nephrologists are all contributing factors [6,7]. For example, there are a few pediatric nephrologists in LMIC: 1/500,000 children in Egypt, 1/10 million in Nigeria.…”

The rise and rise of randomized clinical evidence in Sub-Saharan Africa

“…But its government spends only 0.9% of its GDP on health, well below the low and middle income country average of 3.0% and a fraction of the global mean of 6.8% [13]. Bello et al [13] previously reported that the majority of end-stage renal disease patients in Nigeria are dialysed less than once weekly and that the mean haemoglobin at the time of commencing haemodialysis is 73 g/L [14]. In addition to managing hypertension, diabetes and albuminuria with established treatments, Nigerian nephrologists need to make rationing decisions on CKD therapies that are routinely available in other LMIC countries.…”