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Kidney disease treatment

By Flavia Nassaka

Mulago transplant Program offers hope for lower costs, longer life

Frank Sanyu is on dialysis treatment at Mulago hospital. He started undergoing this treatment in 2012 when he was first diagnosed with acute renal failure. Ever since, his greatest worry has been how he would finally raise money to go abroad for a transplant. Now, this worries him no more since Mulago is to start carrying out kidney transplant operations soon.   Sanyu, 45, was put on dialysis after he visited many hospitals in his upcountry district and his swollen legs problem could not be managed though they prescribed a lot of medicine for him including herbal mixtures.

“One day I woke up when my eyes had bulged too and was rushed to the regional referral hospital, that’s when I was referred to Mulago for further examination. At Mulago, I was told that I had developed chronic kidney failure,” he says meaning the natural process of clearing toxic waste from his body was failing.

In a healthy person, clearing blood of any toxins or unwanted substances in the body is done by the kidney. The kidneys are two bean-shaped organs, each about the size of a fist, located just below the rib cage, one on each side of the spine. The two kidneys filter about 110 to 140 litres of blood daily. This process results in about one or two litres of a waste product called urine, which comprises unwanted waste chemicals and fluids, and is excreted.

Dr. Simon Peter Eyoku, who is with six others comprise Mulago’s renal medical workers team, says when the kidneys fail, as in Sanyu’s case, dialysis treatment is often recommended.  In this case, the dialysis machine replaces the kidney’s filtration function. Mulago has two doctors and five nurses to treat 65 patients on dialysis. The hospital has 22 dialysis machines; eleven of them newly installed but the number of patients keeps rising. Dialysis treatment is also quite costly.  Speaking from a dialysis chair at Mulago, Sanyu says initially it cost him Shs200, 000 per session and he needed three sessions a week.  Fortunately, the fee dropped to Shs60, 000 per session or about Shs500, 000 per month. That was still unaffordable for Sanyu and many other patients since kidney failure means they are too weak to work and earn.

“Even with now a total of 22 hemodialysis machines, only a few patients can access dialysis thrice a week if recommended mainly because of over-crowding,” says Dr Eyoku. He says patients flock Mulago because each session can cost up to Shs500, 000 in private hospitals.  Eyoku says a patient can be on dialysis for the rest of their life – which sadly, is usually very short. The current mortality rate on dialysis is 25% per year. So, out of 10 patients with kidney failure on dialysis treatment, two to three of them will die from failure to keep up even on this significantly subsidized user fee or from other complications of the primary causative pathology. However, there is a better system called allograft transplantation or kidney transplant which offers a superior quality of life and Mulago Hospital will soon be offering it for patients like Sanyu. Until now, kidney transplants could only be done abroad.

Enock Kusasira, Mulago’s Public Relations Officer, says 15 specialists comprising doctors and nurses and supporting staff from Mulago Hospital are to travel to India for three months training at Yashoda Hospitals. This is a centre for kidney transplant.

It is hoped the kidney transplant at Mulago will be cheaper for patients than dialysis as they expected to spend only Shs6 million for the procedure to completely recover.  Having the operation in India costs about US$22,000 (Approx. Shs55 million).

Dr. Eyoku who doubles as the coordinator for the Mulago Hospital Organ Transplant Project says that Block 6A in Mulago will soon be refurbished by Kampala City Council Authority (KCCA) in partnership with a team from South Africa to house the Mulago Renal Center which will comprise a laboratory, pharmacy, dialysis unit, Intensive Care Unit, High Dependency Unit, and two operating theatres.

Protection, Managing Disease

Dr. Eyoku says that chronic kidney disease/failure can be a result of high blood pressure, diabetes, obesity, HIV, autoimmune diseases and self-medication especially on analgesics such as Diclofenac.

To protect one’s self from kidney diseases or to manage it for those already infected, Dr. Robert Kalyesubula, a renal clinician at Mulago recommends proper diet composed of whole grains, fruits and vegetables.

He says that patients should avoid fried potatoes and milk because of the high phosphorous content in them adding that one needs to be well hydrated by taking lots of fluids.

Being cautious about the changes that takes place within one’s body is very important according to the doctor since it helps one figure out an illness at an early stage for instance when the color of urine changes from amber  yellow and appears darker then one should opt for a checkup.

Those with diabetes, high blood pressure or HIV are advised to periodically do kidney check-up so that kidney injury can be detected and treated before translating to acute failure where it may not be reversed by mere medication.

“A kidney patient takes an average of 10 types of drugs and has to stick to the dose. When on medication, one shouldn’t use herbs because using two therapies at a go can worsen the problem,” he advices.

On average, Mulago hospital receives over 1000 kidney patients annually. There are also a number of patients who visit regional referrals and private hospitals.

Worldwide, kidney disease remains one of the most under recognised causes of illness and death because of the lack of heightened index of suspicion or awareness among medical personnel, as well as the general population.

According to Dr. Eyoku, death is rife mainly because most people seek medical care when in advanced stages of ailment, whereas detection at early stages could permit halting   progression or at least mitigating severity of end-organ damage. In many cases, the correct treatment and lifestyle changes can help keep a person and their kidneys healthier longer.

He advises that people with heritable disease conditions such as sickle cell, adult polycystic kidney disease, essential hypertension and Type II Diabetes Mellitus should not inter-marry to curtail disease transmission to the off springs. This can be done through pre-marital medical checkups and a culture of Wellness Clinics.

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