World Kidney Day: Survivors, relatives narrate impact of non-renal coverage of NHIS

Kidney disease, like many other diseases, is treatable if detected early. Femi Ibitokun survived kidney failure and lives to tell his story. But Ahmed Semiu did not.

Ahmed was 15 years old when doctors diagnosed him with the condition.
After that, he had a kidney transplant in India but succumbed to the disease three years after the surgery. Doctors said he died because he could not afford his medications.

Ahmed’s mother had donated one of her kidneys, and his body received it well. However, Ahmed needed to be on medication and constant medical check for life. But his parent could not afford the high cost.

“We raised the money to get him to India through friends, families and voluntary donors. His father had also died from kidney complications. We did all we could to save Ahmed but the cost of dialysis is high.

“Transplant costs a lot. We spent all we had on it, which made managing him after the transplant difficult. He skipped some of his medications because we could no longer afford them,” she said.

Mr Ibitokun was diagnosed with End-Stage Kidney failure in 2010. He told PREMIUM TIMES how the disease was detected by chance. It started with a daily headache which went on for over a month.

“At some point, Panadol Extra was not relieving my pains again. At that point, my legs were swollen; I had lost appetite and stopped eating well. I was working in Ilorin, so I went to the University of Ilorin Teaching Hospital (UITH) where they did a series of tests, which were all inconclusive.”

The hospital referred Mr Ibitokun to the University College Hospital, Ibadan but he decided to go to the Lagos State University Teaching Hospital (LASUTH) instead. There, they conducted a series of tests on him.

“One of the consultants I met in LASUTH advised I do a liver function test, renal function test and a series of other tests. It was there they detected I had a kidney problem. They said I had to start dialysis immediately. My creatinine was very high and the urea was over 300,” he said.

Mr Ibitokun said it was at the dialysis centre the doctor told him he had End-Stage Kidney Failure and would need to be on regular dialysis or go for a kidney transplant, which is the preferable option.

“I had thought I was going to have just one dialysis, but with the diagnosis, I had to do dialysis every week. This I did for 11 months while looking for financial assistance and a kidney donor.

“For the dialysis, I spent N120, 000 every week before I eventually went to India for a kidney transplant. According to my doctor, my kidney failure was as a result of untreated high blood pressure. Unknown to me, I had high blood pressure and never treated it.”

Mr Ibitokun has been on medication since the transplant. He lamented the high cost of the treatment, drugs and check-ups.

Being a civil servant, he is on the National Health Insurance Scheme (NHIS), which covers some of his medical expenses. However, Mr Ibitokun said the NHIS has been of little help to him.

He said the NHIS does not cover his bills for the treatment of the disease. Most of the tests the health insurance scheme covers are insignificant when treating kidney complications.

“The NHIS has not really worked for me. They tell me most of the bills are more than the NHIS can cover. I financed my kidney transplant, medication and routine checkup myself. It has not been easy as they were very costly,” he said.

Mr Ibitokun has been on medication since his transplant in 2011.

“I cannot live a normal life. I have to be on daily mediation which is quite expensive. I am on immunosuppressant drug, steroids and I have to stay away from anything that will cause infection because with the drugs I use, I am susceptible to infections. I have to watch the food I eat; I am on diet as I cannot eat just anyhow,” he said.

He urged the government to look into the cost of treatment of ailments such as kidney failure and cancer, among other diseases because some cases are beyond what individuals can manage on their own.

“I met some Africans in India who said their governments paid for their kidney transplant and all the treatment. The Nigerian government needs to help people even if it has to do with just dialysis.

“If the government can subsidise dialysis, then people can concentrate on finding a kidney donor and the after treatment maintenance. The money spent on treatment is much and the medicine is life long,” he said.

World Kidney Day

Kidney disease is fast becoming a burden to the healthcare system across the world.

The World Kidney Day is observed on the second Thursday in March. It is a global health awareness campaign which focuses on the importance of the kidneys and reducing the frequency and impact of kidney diseases.

The theme for this year’s awareness campaign is “Kidney Health for Everyone, Everywhere.” It aims to highlight the growing burden of kidney disease and kidney health disparity and inequality worldwide.

According to the World Health Organisation, an estimated 850 million people have kidney disease from various causes. Chronic Kidney Disease (CKD) causes at least 2.4 million deaths per year and is now the sixth fastest growing cause of death.

A kidney transplant is considered the most cost-effective treatment of CKD. Unfortunately, it has a high set up cost which requires a highly specialised team, availability of organ donor and infrastructure among others.

Medical expert speaks

A nephrologist with the UCH, Yemi Raji, said kidney complications are treatable in Nigeria. But the cost is very high.

He said the cause of chronic kidney disease in Nigeria include hypertension, diabetes mellitus, chronic glomerulonephritis, and unitary track infections among others. He said Kidney diseases are also hereditary, so such people need to go for medical check-up regularly.

He said there is a need to raise awareness on kidney diseases, the causes of the disease, its prevention and the treatments available.

“We need to raise awareness about the disease. Also, the government needs to step in and intervene in treatment. NHIS needs to cover the cost of treatment for the disease.

“We are using the World Kidney Day to raise global awareness on the disease, especially in Nigeria. The disease is manageable especially if detected early. The only way to detect early is when people go for regular check up. There is something called end-stage kidney failure. at this point, the patient needs to be placed on dialysis and eventually have a transplant. If not the patient would die.”

He said some risk factors which predispose people to CKD include infections like HIV, malaria, tuberculosis and hepatitis.

Mr Raji said most times; patients cannot afford the cost of treatment and the after treatment medication.

“The government needs to come in to finance treatment or make some aspects of the treatment affordable or free just like what is obtainable in some countries.

“The cost of dialysis and transplant is very high. We can carry out a transplant in Nigeria in most teaching hospitals. Also, dialysis centres are available. It is the cost of managing the treatment and after treatment medications that causes most of the complications,” he said.

On how to prevent kidney ailment, Mr Raji advised Nigerians to watch what they eat, exercise regularly, live a healthy lifestyle, reduce intake of non-prescribed medications such as painkillers, and herbal concoctions.

“Kidney disease at times is hereditary. But it can also be caused by people’s lifestyle such as excessive intake of alcohol, use of non-prescribed pain killers (called akapo in Yoruba, or drugs cocktail), obesity, herbal concoction which affects the kidney, high intake of calcium among others.

“To prevent chronic kidney diseases, a regular check-up, exercise and a healthy lifestyle are key,” he said.