TO DEPT OF NURSING SERVICES CONTINUE EDUCATIONS PRESENTATION FMC BIRNIN KEBBI

2. Maxwell Demko
Dialysis Centre, FMC, B/Kebbi
March, 2019

3. The magnitude of the problem of
kidney disease is enormous, and
the prevalence of renal failure is
rising. Currently, renal failure is
emerging as a worldwide public
health problem.

4.  The World Health report 2002 and
Global Burden of Disease Project
reports shows that disease of the
kidney and urinary tract contributed
to the global burden of diseases

5.  with approximately 850,000 death
every year and 15,010,167 disability
– adjusted life years. Globally they
represent the 12th causes of death
and 17th cause of disability.

6.  In Nigeria, the situation is such that
chronic kidney disease represents about
8-10% of hospital admissions. It’s
estimated that every year, the incidence
of CKD is 100 per 1,000,000 population.
i.e. the number of new case of renal
failure every year in the population of 180
million people is 18,000.

7.  The record of all the renal patients on
haemodialysis in Nigeria is less than
2000. If only 2000 people are on dialysis
and 18,000 needed it and when they
don’t get it they die.You can imagine the
number of people dying because they
can’t afford the dialysis.

8. Renal failure is a medical
condition in which the kidneys
fail to perform their functions.

9.  Acute Renal Failure:This is sudden
and often temporary loss of kidney
function.
 Many times its reversible but
depending on the cause and severity.
 It may be irreversible and can lead to
chronic kidney disease.

10.  Shock (hypovolaemic shock)
 Heart failure or heart attack,
 Kidney injury due to accident,
 Medications or drugs,
 Nephrotoxins,
 Infection,
 Prostate problems etc.

11.  Chronic Kidney Disease:This is gradual and
often permanent loss of kidney function.
 In most cases it’s cause by other health
problem that have done permanent damage
to the kidneys little by little overtime.
 If the damage continue to get worse,
kidneys are less and less able to do their job.

12. Diabetes
Hypertension,
Autoimmune disease,
Genetic diseases,
Nephrotic syndrome,
 Infection etc.

13. Transplantation i.e.
kidney transplant
Haemodialysis
Peritoneal dialysis

16. Dialysis is a process where
metabolic wastes and excess
water are removed from the
patient’s blood using a dialyser
(artificial kidney) with the help of
a dialysis machine.

17.  Acute Kidney Injury (AKI)
 Chronic Kidney Disease (CKD)
 Poisoning

18. Pre-dialysis procedure
Seek patient’s consent
Reassure patient and relatives
Discuss financial implications
Health education on avoiding Bp drugs
before dialysis

19. Intra-dialysis procedure
Testing dialysis machines
Setting up the machine
Carnulation
Checking up vital signs every 15
minutes
Documentation

20. Post-dialysis procedure
Dressing the dialysis access
Checking post dialysis vital signs
and weight
Educate patient and relatives on
access care, diet, medication and
next dialysis date

21.  Protein – diets high in lean protein like chicken and
fish are better, they are less in urea
 Sodium – it’s hard for injured kidneys to maintain
body salt and water balance, therefore less sodium
food are advice
 Fluid – too much fluid intake can cause hypertension,
oedema and subsequently pulmonary oedema and
heart failure. Limit water intake in renal patients. Easy
ways to reduce water intake are chewing gum. Suck on

22.  Potassium – too little intake of potassium can
cause muscle cramps, weakness and irregular heart
beat and too much can also cause heart attack.
moderate intake is advice.
 Phosphorus – too much intake of this can cause
weak bones that can break easily. Phosphorus
intake must be limited.

26.  We know the causes of kidney failure, we do
know how to treat people with kidney failure. But
we do not have the machines and the materials to
treat them all. So who get to live and who gets to
die?
 Before 1973, this really happened all across the
country of the United States of America.

27. Hospital had “Life and Death” committees
made up of Lay people and Clergy.They
choose patients for treatment based on age,
maturity, education whether they had
children to support, could afford the care,
and how much they might give back to the
society if they could live. For patients who
were chosen, the cost of treatment was very
high. Some chose death rather than impose

28.  To make sure that people could get
treatment for kidney failure that would
help them live full lives, congress passed
public law 92 – 603, the medicare End
Stage Renal Disease (ESRD) program,
1972. It cover both dialysis and kidney
transplants to patients who are entitled
to social security based on their work
record.

29. The program pays 80% of
allowable cost, then insurance,
the state programs, or patients
pay the other 20%. Once the law
was passed and more machines
were build, shortage were no
longer a life or death problem.

30. Today in the USA, kidney
failure is the only disease with
its own medicare program.
With this program, patients
can live as long as 30 years on
dialysis.

31.  What this anecdotal story alludes to is
the fact that; government funding
changed the lives of people living with
ESRD who needed dialysis to survive.
The same will be required of any nation
that wants to tackle kidney disease.
 In Nigeria, the burden of cost of health
services is being covered by the patient
and their relations.

32.  The recently introduced NHIS in Nigeria
doesn’t cover CKD patients. It’s only for 6
sessions. Furthermore, about 60% of
Nigerian lives below the poverty line
(World fact book). Financial constraint
has been documented by various studies
as a major impediment in renal
replacement therapy (RRT) in developing
countries.

33.  In analysis of cost implication of treatment of
ESRD in Nigeria by Ijoma et al, concluded that cost
of treatment of ESRD was exorbitant and far
beyond the reach of the average Nigerian.
Remember where United States of America was in
1972?

34.  That is where Nigeria is right now in
dealing with kidney failure.
Treatment is available but, it’s for the
selected few that can access and
afford care.
 In view of this, there are quite a few
step that need to be taken to address
this challenge.

35.  The federal government needs to include dialysis
treatment in NHIS program for all qualified
patients.
 The federal government needs to subsidize dialysis
for non qualified NHIS patients.
 The state government and local government need
to create program to subsidize dialysis for

36.  Bringing in medical/dialysis consumables
in to the country should be made duty
free so as to decrease the expenses of
dialysis treatment more than 35% and
help hospital provide quality and
affordable medical services.
 More dialysis centre should be build all
over the country to prevent patient from
travelling long distance for treatment.

37.  Some of the solutions suggested by Nigerian
Nephrologist currently working in abroad are
as follows:-
 According to Prof. Aminu K. Bello tenured
professor of the University of Alberta,
patients with renal failure in developing
countries faces a lot of challenges and poor
outcome particularly relating to access to
dialysis and transplanting.

38.  All over the world, RRT is expensive.
Considering Nigeria’s global ranking as the
7th leading oil producer, it’s a shame that we
are still not able to provide access to care for
our patients with ESRD. Egypt, Sudan and
most other North African countries are doing
much better than Nigeria, even though; they
are nowhere near Nigeria in terms of
economic prosperity.

39.  It’s a challenge to our leaders. Paying for
dialysis and transplantation out of
pocket is quite draining. Advocacy to
leaders must continues.We also need to
have functional primary health care
system where we can identify and
address risk factors for ESRD early, such
as; hypertension, diabetics, elderly and
cardiac diseases.

40.  While the Prof. Ike Okpechi, professor at
University of CapeTown, state that, one of
the things that needs to be improve is the
level of involvement of the government in
the nephro care of patients in Nigeria.The
government needs to support haemodialysis,
peritoneal dialysis, transplantation and
immunosuppressant for all transplanted
patients.

41.  Peritoneal dialysis program is an
effective way of dialyzing patient,
when peritoneal dialysis is readily
available.With a population that is 3
times that of SouthAfrica, Nigeria
should be leading in PD treatment in
Africa if PD fluids can be produced
locally.

42. REMEMBER: It will take
policy changes and
partnership to make
dialysis affordable.

43.  A. Arije, 5 – Kadiri, and O. O. Akinkugbe, “The viability of haemodialysis as a treatment
option for renal failure in a developing economy” African journal of medicine and medical
sciences, vol 29, no. 3 – 4, pp 311 – 314 200.View at goggle school.
 A. K. B. Bello, E. Nwankwo, and A. M. El Nahas, “ Prevention of Chronic Kidney Disease. A
global challenge”, Kidney International, Supplement, Vol. 68, No. 98 PP 511 – 517, 2005
view at published, view at goggle, view at pubmed – view at scopus.
 ADAM Medical Encyclopedia 2012: Acute Kidney Failure, US National Library of Medicine.
 Bernntein, AM;Tray Zon, L, L1, 2 (2007), “Are high protein vegetables based diets fate for
kidney function? A renew of interaction” journal of the American Diabetic Association –
107(4): 644 – 80.
 Medicine Plus (2011) “Chronic Kidney Disease” AD. A. M. Medical Encyclopedia. National
Institute of Health.
 U.S – Renal Data System and USRDS 2005 Annual Data Report, Atlas of the End Stage
Renal disease in the United States National Institute of Health, National Institute of
Diabetic and Diagnosis and Kidney Disease. Bethseda, Med, USA. 2005.
 World Health Organization, “Global Burden of Disease”. March 2006, http: iiwww3 – who
inHwhosis/menu. CFM? Path = evidence.