CHRONIC KIDNEY DISEASE THE ROLE OF GOVERNMENT IN THE MANAGEMENT.

1. CHRONIC KIDNEY DISEASE THE ROLE OF GOVERNMENT IN THE MANAGEMENT. Odonmeta B. Ayo

2. Pre Test 1. CKD is a global health problem 2. The scourge of CKD affects more of the work force age group in the nation 3. The prevalence of CKD in Nigeria is as high as 40% from a community based study 4. From hospital data, the least burden of CKD is in the south-south of the country 5. Diabetes remains the most prominent cause of CKD in the country 6. A tunnelled internal jugular catheter is the gold standard of vascular access for haemodialysis

3. Chronic kidney disease (CKD) remains a global health problem, with an increasing prevalence world-wide. • The high costs of managing this disease in low-income countries cannot be over-emphasized. • While CKD affects mostly the elderly in western countries, In Nigeria and most other countries in the continent, its scourge rests on young and middle –aged adults.

4. The prevalence of CKD in Nigeria has been reported to be as high 20% in community based studies, while hospital based data show 8-10%. • South-South Nigeria with a population of about 15million has the greatest burden of CKD as some hospital data confirms. • A study by Okoye et al carried out in a rural community in the sub-region reports a prevalence of 27.2% , with risk factors such as hypertension, obesity and diabetes being highly prevalent.

5. Hypertension remains the most prominent cause of CKD in the country and continues to contribute to the bulk of ESRD patients seen in tertiary centres, most presenting for the first time in ESRD with florid symptoms. • Other causes include diabetes, chronic glomerulonephritis, HIV, obstructive uropathy etc

6. Renal medicine is one of the most established and advanced medical specialty in the country with over 120 nephrologists nationwide and several renal/dialysis units scattered all over; however the level of care of the typical ESRD patients remains below international standards. • Unfortunately, the cost of managing the disease remains prohibitive to majority.

7. Tell a story. • Government was amazed that most of the cases of support were from kidney disease • Asked to look into it and found out that at least 1 case of renal failure is admitted into the emergency unit of Delsuth daily. • And every clinic day which was once weekly at least 4new cases are seen. • In the dialysis unit of Delsuth, an average of 12new cases for HD were seen per month

8. This was worrisome. • The number of CKD patients was on the increase and care of these patients in terms of haemodialysis and transplantation was way out of reach of most people. • Western world ...... Good health insurance. • Proposal on how we can make it easier on these patients. The recommendation that came from this proposal was as follows:

9. Have more AV fistula creation procedure done for our patients and as such gradually shift to the gold standard of vascular access for HD. • Have some form of subsidy in the cost of haemodialysis( by the state government) • Standardize our laboratory; to a level where we can get very good results and also carry out toxicology screening and HLA typing in view of renal transplantation. • Commence the process of kidney transplantation in the center.

10. Some state government already have some form of assistance in terms of kidney care • Ondo State recently inaugurated a new dialysis complex in the state. The Governor was given an award of excellence at the last NAN meeting. • In Kano and katsina, there is some form of support for their indigenes in terms of haemodialysis. • The first cardio-renal centre in Nigeria was recently setup in Lagos.

11. Delta state has taken a giant step in the management of kidney disease patients • Subsidizing haemodialysis - The cost of treatment in our centre remains the cheapest in the region due to the support of the Delta State government through subsidy, and presently a further 75% subsidy in the cost of both haemodialysis and EPO has been approved by the government. • Subsidizing erythropoietin injections for the patients. • Commencing the kidney transplantation programme – the first two cases were done for free and subsequent cases to come at a subsidized rate of 2.5million naira as against the usual price range of 8 to 10million naira.

12. The Delta state governor( DR E.E UDUAGHAN) was given an award of excellence in renal care at the last NAN meeting in February at Akure. • The level of care and support the State gave to her indigenes in term of kidney disease care was second to none.

13. The leadership of NAN, two years ago met with the minister of health and the senate president to discuss on the role of the federal govt in kidney care and how it can be included in the NHIS. Nothing solid has come out of that yet but the struggle is however still on. • Due to the role of the Delta state government in kidney care in the state....this picture is what we have.

15. CONCLUSION • The country needs to take care of its citizens in all aspects especially in health because healthy citizens make a strong and healthy nation • I believe that each state should play its own role in taking care of the patients and as such the country will have a successful healthcare delivery. • Delta state has started in an excellent manner in taking care of kidney disease patients and we must all strive to sustain this programme which is worthy of emulation.

16. Post Test 1. CKD is a global health problem 2. The scourge of CKD affects more of the work force age group in the nation 3. The prevalence of CKD in Nigeria is as high as 40% from a community based study 4. From hospital data, the least burden of CKD is in the south-south of the country 5. Diabetes remains the most prominent cause of CKD in the country 6. A tunnelled internal jugular catheter is the gold standard of vascular access for haemodialysis

17. THANK YOU AND GOD BLESS.