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March is infamously known as the Kidney disease awareness month and we commemorate the World Kidney Day (WKD) every second Thursday of March. Within this month, awareness is raised about the increasing burden of kidney diseases worldwide as we strive for kidney health for everyone, everywhere. Specifically, the 2020 WKD campaign highlights the importance of preventive interventions to avert the onset and progression of kidney disease.
Kidney disease develops when kidneys lose their ability to remove waste products from the body and maintain fluid and chemical balances. It is the thirteenth leading cause of death in Uganda and greatly impacts on patients’ quality of life. Quality of life is broadly defined as an individual’s perception of his or her life and sense of wellbeing. It embeds the physical wellbeing, psychological or emotional wellbeing, social and spiritual aspects of life. Quality of life is a crucial element in any chronic disease care and kidney disease is no exception. It is indicative of the outcome of the disease and valuable in assessing the effectiveness of any treatment intervention.
Chronic kidney failure is the more common condition where kidney function is lost over months. In the case of acute kidney failure, the functioning declines rapidly within hours or days giving rise to medical complications. If this state continues to the point that the person is no longer producing urine, it is unlikely that the person could survive longer than three weeks. In the case of chronic renal failure, a more gradual process of decline takes place in which the body adapts to the declining state of kidney function and survival maybe months to even a few years. The life expectancy for those afflicted and at the end-stage kidney disease may be prolonged through either a kidney transplant or hemodialysis. However, kidney transplants are not done in Uganda and may cost one over 100 million abroad. Moreover, after a transplant, a patient would need to invest in medicine to sustain the new kidney and this may cost a patient up to two million per month. Owing to the costliness of kidney transplants, many patients in Uganda opt for hemodialysis, a process of using a machine to clean the blood of the waste products.
Hemodialysis is a lifelong process and for it to be effective, one has to visit the hospital at least thrice a week and spend about four hours per visit. Although it may appear cheaper than a transplant, hemodialysis is expensive in the long run. Currently, in Uganda, Kiruddu Hospital offers the cheapest dialysis and here, a patient is required to pay between one to two million shillings to start and a minimum of 160,000 per week for the rest of their lives, excluding money for medications or laboratory tests. In private health facilities, the cost could shoot up to one million shillings per week. This option, therefore, remains equally expensive for the ordinary Ugandan and bears an impact on the patient’s quality of life. For example, a patient undergoing hemodialysis may be unable to work fulltime and may have to sell off properties such as land in order to meet the cost of treatment. This greatly lowers a patient’s quality of life.
Unfortunately, because kidney disease presents meagre or no symptoms in its early stages, many people are unaware that their kidneys have challenges until the disease is in its last stages. Predisposing risk factors to developing kidney disease include diabetes, high blood pressure and infections such as HIV, malaria or pneumonia. According to the U.S. Centres for Disease Control, Diabetes is the number one cause of kidney disease and followed by high blood pressure.
Nonetheless, kidney disease can be prevented and progression to end-stage kidney disease can be delayed. In order to prevent kidney disease, it is important that you avoid self-medication especially of common drugs like Diclofenac and Gentamycin, eat a balanced diet daily, engage in physical activity and get your kidneys checked at least once every year by carrying out a blood and urine test. It’s also important to remind your doctor to check your blood pressure and blood sugar at least once every year. After ascertaining that you have kidney disease, it is important to seek specialist care early and plan your treatment options.
In order to improve the quality of life among patients with end-stage kidney disease in Uganda, I am currently conducting a study on 364 kidney patients in Kiruddu hospital. This study is examining the factors that affect their quality of life and tracking their survival in order to find out what interventions are required to help patients in our hospitals both from the doctors’ and the patients’ points of view.
