The enormous negative impact of non-communicable diseases (NCDs) on public health systems across the sub-Saharan Africa (SSA) region today is receiving much more attention on the policy agenda than it did two decades ago. Amid this commendable progress, however, there is an emerging risk that the importance of kidney health and its interlinkages with much better known NCDs namely heart disease, cancer, chronic respiratory disease, and diabetes might be getting obscured.
This does not in any way imply that preventive efforts to combat the more familiar NCDs should be downscaled but rather there is need for more amplified behaviour change information about prevention of chronic kidney disease (CKD). The urgency to raise awareness about CKD is due to its increasingly devastating impact on lives and livelihoods of communities in low- and middle-income countries in the global South.
Most people know that the role of kidneys is to remove waste from blood in the form of urine. In truth, however, the two bean-shaped organs, located just below your rib-cage and next to the spine, play other important roles as well. These include controlling blood pressure, contributing to the making red blood cells and maintaining healthy balance of water, salt and minerals in your blood. Kidney health is also important for the well-functioning of nerves, muscles and other tissues. In summary, you cannot remain healthy if your kidneys are not functioning optimally.
The NCD Alliance estimates that one in 10 people worldwide are affected by chronic kidney disease, which occurs when kidneys have been damaged over time. It notes that up to 90 percent of kidney function can be lost before any symptoms are experienced, hence the common reference to kidney disease as the “silent killer”.
Like all life-threatening illnesses, the most effective measure towards management of kidney disease is knowing one’s status by having kidney functions tested. The two most common of these are the kidney blood test, which checks the level of a substance known as creatinine produced by breakdown of creatine phosphate from muscle and protein metabolism. The other is a urine test which assesses for presence of protein in urine, which can indicate kidney damage.
Symptoms of kidney disease include high blood pressure; anaemia (low blood count), weak bones, nerve damage, swollen ankles and fatigue. Fortunately, there are lifestyle changes that are known to reduce the chances of developing kidney disease or slowing its progression. These include regular exercise, healthy eating, reduced salt intake, avoidance of cigarette smoking, and controlling one’s blood sugar and pressure. People who have diabetes, hypertension, obesity and family history of CKD should have regular kidney function tests. As such, Governments and policymakers should prioritize public health interventions that promote healthy lifestyles and reduce exposure to risk factors for kidney diseases.
Other than causing a high level of illness and death in poorer countries, CKD puts a very heavy burden on countries and households’ health budgets. In Kenya, the lowest cost of dialysis is US$73 per session, while the cost of a kidney transplant is equivalent to US$2,300 at Kenyatta National Hospital. With the National Hospital Insurance Fund (NHIF) subsidising kidney dialysis, dialysis has become its single-largest medical insurance claim, with the payouts for treatment of kidney failure increasing by 41 percent in 2019 when the agency released approximately KSh. 1.8 billion (US$ 13.8 million). On average, a single dialysis session costs between KSh. 9,500 and 16,000 per session in Kenya. In Ghana, the cost of a session dialysis is in the same range as Kenya from US$60-72. Globally, more than 80 percent of all patients who receive treatment for kidney failure are in affluent countries with universal access to health care and large elderly populations.
With costs for management of CKD being the major factor in the evident inequity in access to these services, governments on the SSA region have had to explore ways of progressing towards equitable access to care for people living with chronic kidney disease. The most plausible of these is nurturing partnerships with the private sector and other non-state actors.
In Kenya, one such partnership is the Interlife Kidney Transplant Project. The Project, which was established in 2009, is a collaboration between Kenyatta National Hospital and Novartis. It is aimed at improving the transplant system not only at KNH but also in the country through capacity building, technological and skills transfer and in the long run building confidence of patients in the Kenyan transplanting system. It is also focused on supporting reduction of cost of post-kidney transplant drugs where all patients transplanted under the program receive subsidized cost drugs from Novartis. By 2019 when it marked its 10th anniversary, the Project facilitated more than 200 successful kidney transplants.
Currently, kidney transplantation is funded by the NHIF to a maximum of $5000. The funding excludes the costs of the pretransplant workup and the post-transplant immunosuppressive medication, which makes it a huge financial burden for patients and their relatives.
As such, screening programs for CKD should be integrated into primary healthcare systems, and healthcare professionals should be trained in the early detection and management of kidney diseases. Early detection and treatment of kidney disease can prevent or delay the onset of other NCDs.
The Writer is the Cluster Head, Novartis East and Southern Africa Cluster.