Uganda continues to grapple with non-communicable diseases, with over 25 percent (about 9million Ugandans) at risk of Kidney diseases, a recent study has revealed.
While the condition continues to bite in, many of the affected persons present to the health facilities very late hence offer limited options of relief or cure. As such they remain imprisoned on their hospital beds buying time and hoping for finances to get kidney transplants or at the very maximum, a miraculous cure.
A recent survey conducted by the Uganda Kidney Foundation, points to an increase in the kidney disease burden.
A quarter of Ugandans above 18 in the country have Kidney disease, this is about 25% of the total population, Dr Robert Kalyesubula, the President Uganda Kidney Foundation reveals.
Kalyesubula, a nephrologist, however adds that many of the people come to hospital when the condition is in its advance stage.
“55 percent of the patients come when the condition is in stage five with very minimal clinical options,” he said.
Kalyesubula continues that even with the numbers that flock the health facilities, only a handful can afford the complete medication for the kidney issues, which involves dialysis.
“Only 10% of our patients who need dialysis for medication can actually afford it.”
Dialysis is the process of removing excess water and toxins from the blood in people whose kidneys can no longer perform these functions naturally.
However, while the process is crucial for long life among patients with kidney diseases, Uganda still struggles with availability of dialysis Machine.
“Kiruddu where dialysis is done has only 19 machines, with 26 machines in private facilities, we need about 500 machines to handle the demand,” Kalyesubula said.
62-year-old Vincent Byaruhanga, a resident of Masindi Kihande village, narrates the pain of accessing dialysis machine at Kiruddu Hospital, one of the few centres in Uganda.
“It is expensive, sometimes it costs about Shs100,000 a day, you need two sessions in a week that is about Shs200,000.”
Dr Peace Bagashe, a nephrologist at Kiruddu Hospital explains that initially, dialysis cost Shs 350,000 per session but this has since been reduced to Shs60,000 per session amounting to Shs120,000.
“Alternative medication is a transplant which is also quite expensive at Shs150m in India, but some bodies later reject the donated Kidney.”
Worrying however, is that for many people diagnosed with Kidney disease there are no signs, in a few people the warning signs may include; decreased urine output, although occasionally urine output remains normal, fluid retention, causing swelling in your legs, ankles or feet, fatigue and confusion.
Patients already diagnosed with other non communicable diseases like Hypertension and diabetes however need to have regular kidney check ups.
Amidst a rising demand, Uganda only boosts of 8 kidney doctors.
“It needs about Shs100m to train in kidney management, and this is also not done in Uganda,” Bagashe said.
The few available medics have embarked on training medical students with hope that these will pick interest in specialising in kidney Disease management and care.
Mulago Hospital has 120 cases a week
At least 120 people are registered at Mulago National Referral Hospital for dialysis due to kidney failure on a weekly basis, according the hospital authorities.
According to the hospital statistics, out of every 100 referral cases to the facility, 20 of them are kidney related complications.
The hospital Executive Director, Dr Byaruhanga Baterana, says that the ultimate goal of many patients undergoing dialysis is to obtain a kidney transplant, hence it is the reason the hospital of working speedily to launch an organ transplant unit.
Baterana says that the unit is in its final stages of completion with 90% of the work done. The unit will be accessible to Ugandans albeit at a fee.
“The people will be able to make some contribution towards the fees especially in buying consumables as well as medicines that they are pre-medicated on before, during and after the transplant,” Baterana said,
He however maintained that the contributions will not be general as there will be a committee to vet patients and determine whether they are able to make the contribution or waiver on those incapacitated.
The unit will be operating on at least two people on a weekly basis with each operation costing between Shs20m to Shs25m. This is far less than the Shs90m required for the same in India.
Law on organ transplant
There is no law governing organ transplant in Uganda at the moment hence organ transplant can’t happen.
Uganda currently follows the World Health Organisation’s (WHO’s) Guiding Principles on Human Cell, Tissue and Organ Transplants which only allow harvesting of a needed organ from a living donor.
In June 2011, Prime Minister Ruhakana Rugunda confirmed that government was drafting a law that will incorporate tissue and organ transplant in Uganda.
In June last year, Acting Director General of Health Services in the Ministry of Health, Dr Anthony Mbonye, said the principles of the Organ and Human Transplantation Bill, which target to regulate the organ transplantation, donation, harvesting and importation into the country, had been submitted to Cabinet but it is yet to be ready as of this day.
Dialysis performs the function of the kidneys if they have failed. According to the National Kidney Foundation, end stage kidney failure occurs when the kidneys ae performing at only 10-15 per cent of their normal function.
Therefore, in that condition, machines are employed to purify the blood so it can balance fluids or do the work kidney should have done. It is in other simple terms what one could call kidney-life support.
Properly functioning kidneys prevent extra water, waste, and other impurities from accumulating in your body. They also help control blood pressure and regulate the levels of chemical elements in the blood.
When your kidneys can’t perform these functions due to disease or injury, dialysis can help keep the body running as normally as possible. Without dialysis, salts and other waste products will accumulate in the blood, poison the body, and damage other organs.
There are two types of dialysis; namely haemodialysis, where the blood is put outside the body, purified and then returned to the body.
The second type is peritoneal dialysis, where the blood is cleaned from inside the body. It involves placement of a special fluid in the abdomen of a patient to absorb the waste from the blood which passes through vessels in the abdominal cavity. The fluid is then drained.
But what causes Kidney failure
According to American Kidney Fund website;
In most cases, kidney failure is caused by other health problems that have done permanent damage (harm) to your kidneys little by little, over time.
When your kidneys are damaged, they may not work as well as they should. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease, or ESRD for short.
Dibetes is the most common cause of ESRD. High blood pressure is the other cause plus; Autoimmune diseases, Genetic diseases and urinary tract problems.
Sometimes the kidneys can stop working very suddenly (within two days). This type of kidney failure is called acute Kidney Injury or acute renal failure. Common causes of acute renal failure include:
- Heart attack
- Illegal drug use and drug abuse
- Not enough blood flowing to the kidneys
- Urinary tract problems
This type of kidney failure is not always permanent. Your kidneys may go back to normal or almost normal with treatment and if you do not have other serious health problems.