(ABUJA, FEDERAL CAPITAL TERRITORY, NIGERIA OCTOBER, 16th, 2015): KidneySolutions kidney disease and dialysis center Lagos had the 1st of its growing dialysis population of patients undergo a very successful live donor kidney transplantation on the 16th of October 2015 at the Garki Hospital Abuja.

"In a country as populous as Nigeria and with probably several hundred transplant procedures performed outside the country every year, there has been a dire need for capacity building to offer such services in Nigeria. There are already a large number of well trained Nigerian healthcare professionals trained in the best institutions in the world making efforts to be part of the healthcare revolution back home and this among other efforts sends home the point that where the right support and resources are applied, excellent medical care and outcomes can be achieved. Today marks the first of hopefully many other patients who will elect to have kidney transplantation surgery in Nigeria instead of having to go abroad" says Dr Anekwe, medical Co-Director of KidneySolutions kidney disease and dialysis center Lagos.

While early efforts at prevention, early detection and active involvement of kidney specialists in the care of patients with kidney disease has an important role to play in reducing the physical and socioeconomic impact of such an emotionally devastating and expensive condition like kidney failure, there needs to be the infrastructure and resource commitment in the country to cater for those patients who inexorably progress to end stage kidney failure despite best efforts or due to late detection. The identification and establishment of key centers for kidney transplantation across the country is key to capacity building and is sorely needed.

Experts from around the world and from within Nigeria were present for the procedure. The lead surgeon was Professor Nadey Hakim, a world renowned transplant and bariatric surgeon and former president of the International college of surgeons supported by Dr Miner, the chief Medical director of Garki Hospital, Dr Egbuna- transplant nephrologist and Assistant Clinical professor of Medicine at the David Geffen School of Medicine at the University of California Los Angeles, urologists, nephrologists, general surgeons, anaesthesiologists, nurses and technicians. All team members world flawlessly on both the living kidney donor and the recipient to result in a successful and hitch free procedure. This is the 9th kidney transplant performed at Garki hospital, the 7th patient from KidneySolutions undergoing a transplant and the 1st patient from KidneySolutions undergoing kidney transplantation in Nigeria. Since this transplant, the 10th transplant has also been performed and that patient is also doing very well.

Healthcare providers, patients and members of the general public interested in supporting patients or participating in the transplant program may contact the clinical administrator and senior medical officer-in-charge, Dr Aderemi Oladapo-Sanu at No 3 Tunde Gafar Close, Off Adeniyi Jones, Ikeja, Lagos or call at +2348034853935 or +2348115707684. More information can also be obtained by visiting the KidneySolutions website at http://www.kidney-solutions.com/.

About KidneySolutions: KidneySolutions was established by a group of US trained nephrologists, pharamacists and business professionals with a mission to provide the highest quality service by transforming the promise of science, technology and medicine into service that transforms, prolongs and saves the lives of patients with all stages of kidney disease.

About Garki Hospital: Garki Hospital Abuja is owned by the Federal Capital Territory Administration (FCTA). It was closed in 2001 for full renovation. In March 2007, a concession agreement for the management and operation of the new Garki Hospital Abuja was signed between FCTA and Nisa Premier Hospital, after a competitive bidding process. This is in line with the Federal Governments Public Private Partnership (PPP) Policy. Today Garki Hospital Abuja is a model 100 plus bedded hospital in the FCT breaking barriers and setting the pace in both general and specialized services such as open heart surgery, kidney transplantation and in-vitro fertilization. The center as of October 2015 has performed over 40 open heart surgeries.

Contact: Dr Aderemi Oladapo-Sanu. Email: [email]info@kidney-solutions.com[/email]. Phone +2348034853935 or +2348115707684

This is a really informative article about the function of the kidney and basic information that could help in understanding kidney disease.
It is written in simple to understand words and can really help if you, a family member or friend need information to help you overcome the problem.
For instance, did you know that you could loose up to 80% of your kidney function before experiencing any symptoms? At that time it might be too late but there are suggestions to help you know if you are at risk and what the symptoms might be.

To read more about the function of the kidney and kidney disease visit this link at https://kidneysolutions./2015/09/15/frequently-asked-questions-about-kidney-disease/.


Happy reading!

Important summary on the HIV epidemic and associated kidney disease in Nigeria for healthcare providers and the curious non health professional. Myths about safety of HIV medication and kidney transplantation in patients with HIV are also discussed.

To read more visit this link http://createsend.com/t/t-C17A72E7ED224956

Based on a 2012 UNAIDS report, approximately 3.4 million people are living in Nigeria with HIV infection and in 2011 about 210,000 people died from the infection. Patients unable to access treatment for their HIV frequently end up with HIV related disease of the kidney in addition to other complications of HIV such as opportunistic infections like tuberculosis and pneumocystis pneumonia. For patients able to consistently access effective anti-retrovirals therapy (ART) and care, life expectancy is prolonged by decades and effective in preventing and even treating HIV associated nephropathy (HIVAN). Prolongation of life from ART however, permits opportunities for other non-HIV diseases of the kidney which healthcare providers must be aware of and identify. To learn more visit http://createsend.com/t/t-C17A72E7ED224956

Sharing an interesting post that many should find helpful about the diabetes (High blood sugar) and kidney disease epidemic growing too fast in Nigeria. Diabetes is among the most common causes of kidney disease and the need for kidney dialysis or kidney transplant.

According to a 2014 International Diabetes Federation (IDF) report, approximately 46 out of every 1,000 adults in Nigeria between the age of 20 and 79 years have diabetes with an estimated 4 million cases many of which are undiagnosed. Several thousands are estimated to die from diabetes related conditions every year. Some women may develop diabetes during pregnancy resulting in large babies, or other problems in pregnancy. After the pregnancy, the diabetes may disappear but for some patients, it is the beginning of what will later present as full blown diabetes.

To read more about diabetes and kidney disease in Nigeria, click the following link. https://kidneysolutions./2015/05/12/diabetes-and-kidney-disease-in-nigeria/

To learn more in general about kidney disease visit this link- http://www.kidney-solutions.com/faq/

As the name suggests, polycystic kidney disease (PKD) is a disease where there is an abnormal formation of many fluid filled sacs in the main tissue of the kidney and occasionally in other organs such as the liver. These fluid filled sacs are not cancerous but in regions where these sacs or cysts exists, the normal organ tissue there is destroyed. These fluid filled sacs increase in size and further damage nearby normal tissue causing a worsening of organ function. The enlargement and increase in number of the cysts often leads eventually to kidney failure and only very rarely does the disease lead to liver failure. Enlargement of the cysts often occurs over years but once established for the time being, they cysts are not reversible.

There are several genetic and inheritable kidney diseases and polycystic kidney disease (PKD) is the most common of them all. It affects several thousand Nigerians and others around the world as well. Approximately 2 to 3 of every 20 cases of kidney failure requiring dialysis or transplant is due to polycystic kidney disease. In Nigeria, while there is no strong evidence, some studies suggest the likelihood of having PKD is higher among men than women.

To learn more about this disease click on this link - https://kidneysolutions./2015/04/11/polycystic-kidney-disease-pkd-in-nigeria-get-the-facts/

To learn more in general about kidney disease visit this link- http://www.kidney-solutions.com/faq/

Discussion on the kidney disease epidemic in Nigeria. The headline probably under appreciates the magnitude of the risks and problems many Nigerians face with this serious problem but it is certainly worth a read for those interested in learning more.

http://www.tribune.com.ng/your-health/item/31068-expired-tetracycline-can-cause-kidney-failure/31068-expired-tetracycline-can-cause-kidney-failure

‬Or you can learn more at the KidneySolutions websites at http://www.kidney-solutions.com/faq/

This is an interesting topic on what people who intend to donate a kidney for transplant must know for the best possible outcomes.

Wanting to donate a kidney to improve or even save the life of another person suffering from kidney failure is a nobel and honorable thing. The donation of a live kidney is the best option for the recipient compared to donation from a deceased person as it will last longer and work better if put in properly and taken good care of. It is also certainly offers the recipient of the kidney a better and longer life compared to continued dialysis.

However, the most important thing for you to know about kidney donation as a possible donor is that donation is not safe for everybody.

Your primary responsibility is to ensure that it is safe for you to donate a kidney.

The doctors primary responsibility to you as a potential donor is to help you determine if it is safe for you to donate and nothing else.

If you do not really want to be a donor for whatever reason, you should not be forced to do so. Talk to the doctor evaluating you as a donor in private and tell the doctor your concerns. Your doctor will be able to speak confidentially on your behalf and tell the person hoping to get the kidney from you that you are not medically fit to be a kidney donor. The doctor does not need to tell them of your fears or concerns unless you ask them to do so.

First things first – who can donate a kidney? To read more- click on the link below......

http://kidneysolutions./2015/01/02/living-kidney-donation-what-the-donor-must-know/

The Nigerian Association of Nephrology has taken some bold steps to alter the near epidemic trends in incidence and prevalence of kidney disease in the Nigerian population. A very thoughtful document that requires the support of all well meaning Nigerians and the government.

http://www.nanephrology.org.ng/index.php/education/proposed-national-renal-care-policy

All stakeholders- patients, healthcare providers, health insurance and other payors, regulatory bodies and the government should be involved to ensure that all points of view are included in the final policy.

Please share this with your friends and with your local, state and federal government representatives. Let them hear your voice. Nigeria is plagued with a lot of issues and this might not seem like an important one but consider the following.
1. Majority of affected patients in Nigeria are young between the ages of 25 and 40 years of age.
2. 70-80% of patients first see a kidney specialist when they need dialysis or transplant rather than when they have earlier stages of kidney disease that might be reversible.
3. Death from kidney failure in Nigeria for the majority of people is fairly high. More than 8 out of 10 patients with kidney failure are dead within 1 year of their diagnosis.
4. It is estimated that only 1 in 10 patients needing dialysis get it at all.
5. 1 or 2 out of every 10 patients admitted to a general hospital are likely to have some form of kidney disease or failure.
6. A years worth of dialysis and medications currently costs between 5 and 6 million naira. This does not cover events that might require hospitalization or medications or treatments for other medical issues a patient might have. 

Herbal remedies have their "possible" benefits as they were used by our ancestors for millenia.
However, they are not standardized, and the practice of those who prescribe them is not regulated as orthodox doctors are regulated by both MDCN and NAFDAC.

Herbal medicines are apparently beneficial for many ailments but have unintended consequences such as stomach ulcers or even kidney failure. So beware- while an herbal remedy might help with heart burn, it may put you in the hoospital for something else.

Read this interesting post on the role of herbal medicines in causing kidney failure in Nigeria here. http://kidneysolutions./2014/04/13/upcoming-blog-post-may-2014-environmental-causes-of-kidney-disease-and-failure-in-nigeria-a-big-public-health-problem/.

There are many other environmental and occupational causes of kidney failure but the section in this post on traditional herbal remedies is very relevant to the discussion here.

Hope this helps.

It is important to raise awareness during world AIDS day because there are still an alarming number of patients with HIV and AIDS in Nigeria. In fact the numbers about the number of new and existing cases of patients with HIV in Nigeria are alarming and among the highest in the world.

A lot of this is related to sexual behaviours and unprotected sex. However an under appreciated cause of transmission of HIV and other dangerous infections is tainted blood transfusions infected not only with HIV but with other viruses and bacteria such as Hepatitis B, Hepatitis C and syphillis. We need to be more conscious about blood donor testing. Increasing standards for blood banks and hospitals screening of blood donations and reducing the financial motivation for donation is an important step to reducing transmission of HIV and related infections by blood donation.

To help understand the magnitude of the problem with infected but asymptomatic blood donors, I refer readers to this post - [url]http://kidneysolutions./2014/03/28/viral-infections-in-kidney-disease-and-dialysis-patients-in-nigeria-truths-myths-and-what-to-do/. [/url]

The post talks about the relevance and danger to patients with kidney disease but it is also relevant to many other groups of people and patients.

Enjoy the read. Stay healthy and get tested.

Really interesting discussion.
I found this really interesting post about environmental and occupational causes of kidney disease and bleaching creams with mercury in them were cited as dangers to health because of the damage to the kidney they can cause. I would really beware of many chemical and herbs.

To read this interesting post look at the following link- http://kidneysolutions./2014/04/13/upcoming-blog-post-may-2014-environmental-causes-of-kidney-disease-and-failure-in-nigeria-a-big-public-health-problem/

Happy reading

Here are 12 simple tips you should apply to your life to ensure you do not develop kidney disease or control the kidney disease so that it does not get worse.
For more information on kidney disease visit [url]http://www.kidney-solutions.com/faq/[url] and for additional information on specific issues such as alcohol and smoking visit the KidneySolutions blog at http://kidneysolutions./2014/08/31/the-silent-actors-in-the-drama-of-kidney-disease-smoking-and-alcohol/

1. Manage diabetes (also called high blood sugar), high blood pressure and heart disease: In most of the cases, kidney disease is a secondary illness that results from a primary disease or condition such as diabetes, heart diseases or high blood pressure. Therefore, controlling sugar levels, cholesterol and blood pressure by following a healthy diet, exercise regimen and medication guidelines is essential to keep kidney disease at bay.

2. Reduce the intake of salt: Salt increases the amount of sodium in diet. It not only increases blood pressure but also triggers the formation of kidney stones. Here are a few tips to actually cut down your salt intake.

3. Drink lots of water every day: Water keeps you hydrated and helps the kidneys to remove all the toxins from your body. It helps the body to maintain blood volume and concentration. It also helps in digestion and controls the body temperature. At least 8-10 glasses of water a day is a must.

4. Don’t resist the urge to urinate: Filtration of blood is a key function that your kidneys perform. When the process of filtration is done, extra amount of wastes and water is stored in the urinary bladder that needs to be excreted. Although your bladder can only hold a lot of urine, the urge to urinate is felt when the bladder is filled with 120-150 ml of urine.
So, if you start ignoring the urge to go to the restroom, the urinary bladder stretches more than its capacity. This affects the filtration process of the kidney.

5. Eat right: Nearly all processes taking place inside your body are affected by what you choose to eat and how you eat. If you eat more unhealthy, junk and fast food, then your organs have to face the consequences, including the kidneys. Here’s more information on the relation between unhealthy diet and kidney damage.
You should include right foods in your diet. Especially foods that can strengthen your kidneys like fish, asparagus, cereals, garlic and parsley. Fruits like watermelon, oranges and lemons are also good for kidney health.

6. Drink healthy beverages: Including fresh juices is another way of drinking more fluids and keeping your kidneys healthy. Juices help the digestive system to extract more water and flush out wastes from the body. Avoid drinking coffee and tea. They contain caffeine which reduces the amount of fluids in the body. So, the kidneys have to work harder to get rid of them. Read more about how soft drinks and sugars can affect the kidneys.
If you’re already suffering from kidney problems, you should avoid juices made from vegetables such as spinach and beets. These foods are rich in oxalic acid and they help in the formation of kidney stones. But you can definitely have coconut water. Here’s how coconut water can help in preventing kidney stones.

7. Avoid alcohol and smoking: Excess intake of alcohol can disturb the electrolyte balance of the body and hormonal control that influences the kidney function. Smoking is not directly related to kidney problems but it reduces kidney function significantly. It also has an adverse effect on heart health which can further worsen kidney problems.

8. Exercise daily: Researchers believe that obesity is closely linked to kidney related problems. Being overweight doubles the chances of developing kidney problems. Exercising, eating healthy and controlling portion size can surely help you to lose extra weight and enhance kidney health. Besides, you will always feel fresh and active. Here’s more about how obesity and kidney disease are linked.

9. Avoid self medication: All the medicines you take have to pass through the kidney for filtration. Increased dosage or taking medicines that you are not aware of can increase the toxin load on your kidneys. That’s why you should always follow dosage recommendations and avoid self medication. Read more about how drugs affect the kidneys.

10. Think before you take supplements and herbal medicine: If you’re on vitamin supplements or if you’re taking some herbal supplements, you should reconsider your dosage requirement. Excessive amount of vitamins and certain plant extracts are linked to kidney damage. You should talk to your doctor about the risk of kidney disease before taking them. Be careful about traditional remedies especially if you are older, have high blood pressure or have high blood sugar. What might be good for headaches may destroy your kidneys.

11. If you have a personal history of kidney disease, or you have high blood pressure or high blood sugar or are over the age of 45 years or have an immediate family member with a history of kidney disease, you should see a kidney doctor. Keep to the appointments, these appointments will be cheaper than avoiding them and paying for expensive dialysis or transplant. If you are diagnosed with high blood pressure or high blood sugar, do not stop the medication unless your doctor tells you to do so.

12. If you are reading this post, you probably would benefit from testing of your kidney function. The tests of your blood and urine to determine your kidney function are cheap and can be done in almost any lab. Ask a doctor to tell you what the results mean. If they are normal, get repeat testing at least once a year and keep on doing everything outlined in steps 1 to 11. If there is a problem, work carefully with your doctor to find the right kidney specialist to help you avoid progressive kidney disease that could result in kidney failure.

Thanks for reading. Stay healthy.

As a follow on to an earlier blog post on the silent way alcohol and smoking increase the likelihood of kidney disease, there has been an interesting post by a leading Nigerian health blog - Nigeria Health Watch, about a tobacco bill in the Nigerian senate. Please provide your thoughts on the bill. Should it pass? Do you oppose or support it? If you oppose it, can you share your reasons for opposing it. It is one of the most important health related bills being handled by elected Nigerians after health insurance.


For the Nigerian Health Watch article on the bill, click here- http://nigeriahealthwatch.com/we-cannot-be-complacent-about-the-nigeria-tobacco-control-bill/

For our article on the silent and significant risk smoking and excessive alcohol pose for developing kidney disease, click here - http://kidneysolutions./2014/08/31/the-silent-actors-in-the-drama-of-kidney-disease-smoking-and-alcohol/

Happy reading.

This is a brief summary of a recent blog post on the KidneySolutions blog page. For more information on the topic, visit, the blog post at
http://kidneysolutions./2014/09/20/reproduction-and-pregnancy-what-men-and-women-with-kidney-disease-on-dialysis-or-with-a-kidney-transplant-should-know/

For more information on Kidney disease, dialysis or kidney transplantation, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page at[url] https://www.youtube.com/user/KidneySolutions1[/url] for lots of free educational information. You can also send email to- [email]info@kidney-solutions.com[/email].

While most people trying to conceive do not have kidney disease, there is no doubt that kidney disease is becoming a growing problem. In addition, the role undiagnosed kidney disease in men or women interfering with ability to have a baby may be underestimated.

Having a child is a joy but conceiving or carrying a baby to term can be a challenge if you have medical problems. A question that likely crosses the mind of many people of reproductive age, male or female is – “will i be able to have children?”. The good news is that many of the causes of reduced reproductive capability in patients with kidney disease are known and can be treated by carefully following the instructions of knowledgeable specialists in kidney disease and reproduction.

This post will aim to address the background behind reproductive potential of patients with kidney disease and answer questions of relevance to patients with either advanced kidney disease, those undergoing dialysis treatment or those who have a kidney transplant. The information in this post is NOT a substitute for close consultation with a kidney specialist and readers are advised to seek the counsel of such experts to address their care and concerns.[i][/i]

Happy reading and may you multiply abundantly!

This is a brief summary of a recent blog post on the KidneySolutions blog page. For more information on the topic, visit, the blog post at http://kidneysolutions./2014/08/31/the-silent-actors-in-the-drama-of-kidney-disease-smoking-and-alcohol/

For more information on Kidney disease, dialysis or kidney transplantation, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page at[url] https://www.youtube.com/user/KidneySolutions1[/url] for lots of free educational information. You can also send email to- [email]info@kidney-solutions.com.[/email]

Chronic kidney disease (CKD) is a growing worldwide problem that is increasingly shown to be interwoven with cardiovascular disease (CVD), smoking and excessive alcohol consumption. In addition, because of the kidneys’ important and varied role in the body, impairment of their function can result in a range of disorders, from mild differences in fluid balance to acute kidney failure and death. Alcohol, one of the numerous factors that can damage and reduce kidney function, can interfere with kidney function directly, through short term excess or long term consumption, or indirectly, as a consequence of liver disease.

The benefits of smoking or alcohol consumption are very difficult to identify and are at best minimal and of no real tangible benefit to its users. However, the harmful effects of these common social pleasures are well documented but not commonly known.

This post is aimed at educating readers on the harms of these silent actors to a common and growing problem of kidney disease and kidney failure. In summary, there is no safe amount of cigarette smoke to be exposed to. There are levels of alcohol intake above which health problems occur including kidney disease.

Happy reading.

What is the function of the kidney?
What is kidney disease?
What are the causes of kidney disease?
How do I know if I have kidney disease?
How do i prevent progression of kidney disease?

For answers to these frequently asked questions about kidney disease and more visit [url]http://www.kidney-solutions.com/faq/. [/url]

This is a brief summary of an earlier blog post on the KidneySolutions blog page. For more information on the topic, visit, the blog post at
[url]http://kidneysolutions./2014/08/03/food-and-the-patient-with-kidney-disease-or-kidney-failure/. [/url]

For more information on Kidney disease, dialysis or kidney transplantation, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page at https://www.youtube.com/user/KidneySolutions1 for lots of educational information. You can also send email to-[email] info@kidney-solutions.com[/email].

[b]Summary: There is a lot of dangerous and misleading information on the right diets for patients with kidney disease often without any scientific or truly tested medical basis for claims. This can lead to malnutrition or even an acceleration of the kidney disease the proposed diet is meant to prevent. A lot of the proposals do not consider the stage of kidney disease a patient is in as well. For instance there is a common belief that protein is bad for kidney disease and this is not true. Protein is an important nutrient and kidney disease does not change its importance. What many people do not know is that we take more protein in a usual diet than the body actually needs so reducing the amount in patients with less severe kidney disease especially before dialysis can slow don but not reverse the kidney disease. Many other aspects of care are likely more important than protein intake to reduce the progression of kidney disease such as control of blood sugar, control of blood pressure and relief of any obstruction. Happy reading and remember to go to the link for more detailed information![/b][i][/i]

Kidney function is essential for removing the waste material and some toxins from food that you eat. The kidneys excrete a dietary protein called urea, as well as excess amounts of sodium, potassium, and phosphate. These substances can build up in the body if kidney function is impaired and cause harm.

Following a strict diet can lessen the excessive accumulation of these substances and their bad effects on the body.

Controlling your phosphorus (Phosphate)

Excess phosphorus is a mineral that healthy kidneys get rid of in the urine. In kidneys that are failing, phosphorus builds up in the blood and may cause many problems including muscle aches and pains, brittle, easily broken bones, calcification of the heart, skin, joints, and blood vessels. To keep your phosphorus levels in check, consider the following tips:

1. Intake of foods low in phosphorus

Grape, Vegetables: cabbage, green beans, spinach, lettuce, carrot, cucumber, pear, plum, Pineapple, apple, mango, white bread, pasta, watermelon, potatoes
2. Moderate intake of moderate phosphorous foods and avoiding high phosphate foods.
3. Remember to take any phosphate binders your doctor may prescribe.

Controlling your Potassium

Potassium is an element that is necessary for the body to keep a normal electrical activity and water balance between the cells and body fluids. All foods contain some potassium, but some contain larger amounts.

Normal kidney function will remove potassium through urination. Kidneys that are not functioning properly cannot remove the potassium in the urine, so it builds up in the blood. This can be very dangerous to your heart. High potassium can cause irregular heart beats and can even cause the heart to stop if the potassium levels get to high.

Typically, there are no symptoms for someone with a high potassium level. If you are concerned about your potassium level, check with your doctor, and follow the tips below.

The following foods are high in potassium and intake of these foods should be limited:
Bananas, Avocado, Oranges, Orange Juice, Prunes, Prune Juice, Tomatoes, Tomato Juice, Tomato Sauce, Tomato Puree, Melon, Nuts, Pawpaw, Chocolate, Red Beans, Milk White Beans, cabbage, onions, groundnut, walnut, mushrooms, corn, potatoes

Controlling your sodium (salt)

Sodium, or sodium chloride is an element that is used by all living creatures to regulate the water content in the body. Usually a sodium restriction comes in the form of “No Added Salt.” This is necessary because a greater intake of sodium will result in poorly controlled blood pressure and excessive thirst which can lead to difficulty adhering to the fluid restrictions in your diet. However, your doctor can allow you a limited amount of sodium which can vary between 2-6gms per day

To limit your sodium, you should:

Avoid table salt and any seasonings that end with the word “salt”
Avoid salt substitutes (they contain potassium)
Avoid salty meats such as bacon, ham, sausage, hot dogs, lunch meats, canned meats
Avoid salty snacks such as cheese curls, salted crackers, nuts, and chips
Avoid canned soups, frozen dinners, and instant noodles
Avoid bottled sauces, pickles, olives, and MSG

Controlling your protein

Protein is important to aid in growth and maintenance of body tissue. Protein also plays a

role in fighting infection, healing of wounds, and provides a source of energy to the body.

For patients with advanced kidney disease not yet on dialysis, it is important that you take some protein but do not take too much. Remember, you need protein for all of the functions above. The reason for asking patients to reduce their protein intake when they have significant disease but are not yet on dialysis is that an excessive protein load can accelerate the path to kidney failure. However note that many other aspects of care are likely more important than protein intake to reduce the progression of kidney disease such as control of blood sugar, control of blood pressure and relief of any obstruction.
For patients with kidney failure, there is absolutely no need to restrict protein as the kidneys have failed and protein restriction will not restore kidney function that has been lost.
You should make sure to eat one tenth of a kilogram of protein every day.
Foods that are high in protein include beef, pork, veal, chicken, turkey, fish, seafood, and eggs.
1 average sized egg for example is equal to one-twentieth of a kilogram of protein.

How to be successful on a renal diet

Moderation

Dietary Guidelines emphasizes the importance of eating a variety of foods. This applies to dialysis patients, too. You can enjoy all foods in moderation while following a renal diet. One of the guidelines states:

“Be sensible: Enjoy all foods, just don’t overdo it.”

This is a link to an article on an important question originally posted on the Nigeria Health Watch website on the 15th of July 2014.

What do you think?

For access to the full article, click on this link? http://nigeriahealthwatch.com/can-the-returning-diaspora-professionals-inspire-improved-quality-in-the-health-sector/

This is a brief summary of an earlier blog post on the KidneySolutions blog page. For more information on the topic, visit, the blog post at http://kidneysolutions./2014/04/13/sickle-cell-anemia-and-kidney-disease-in-nigeria-a-brief-review/

For more information on Kidney disease, dialysis or kidney transplantation, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page at[url] https://www.youtube.com/user/KidneySolutions1[/url] for lots of free educational information. You can also send email to-[email] info@kidney-solutions.com[/email].

Summary: Nigeria has the highest density of people living with sickle cell disease in the world. Sickle cell disease also has direct impacts on the kidney in some sickle cell patients. This post will summarize what is known about kidney disease due to sickle cell anemia and the basics of its management for the lay person. Distinction between sickle cell disease and sickle cell trait and the impact of either on kidney function will also be discussed.

The red blood cell is an important cell component of the blood and functions to deliver oxygen to all the tissues. Each red blood cell contains what is called hemoglobin, the vehicle for carrying oxygen within the red blood cell. Abnormalities of the hemoglobin in the red blood cell can make the red blood cell function abnormally and cause serious problems in tissues of the body including the bone, brain, intestines, lung and even the kidney.

Sickle cell disease is also called sickle cell anemia or drepanocytosis. It is a hereditary disorder of red blood cells most common in Africa and in persons of African descent where under stressful conditions such as infection, dehydration or low oxygen tissue supply, the red blood cells assume an abnormal rigid sickle shape- a process called sickling. Sickling decreases the flexibility of the red blood cell makes the red blood cell unable to pass through the blood vessels easily and for this reason reduces oxygen supply to tissues including the kidneys. If this sickling happens sufficiently, it can cause damage in these tissues and even death.

There is also a less severe form of the sickling condition called the sickle cell trait or “AS” condition, where in simple language only half of the hemoglobin expressed is at sickling risk. Because the other half of their available hemoglobin is normal, they can provide oxygen better to tissues and are at much lower risk for clinical problems although if stressors are very severe, they may develop crises.

The number of people living with sickle cell disease is highest in Nigeria where over a million people live with the full sickle cell disease (SS) and over 30 million live with the sickle cell trait (AS). There are also high numbers of people born with the disease in east Africa (specifically, the Democratic Republic of Congo) and India. It has been estimated that about 90,000 babies were born with sickle cell disease in 2010 and this number is expected to grow to about 150,000 in 2050. This therefore means that a larger number of people will be alive with the disease and attention has to be paid by doctors in caring for the people as the number of cases of kidney disease due to sickle cell anemia will also increase.

Sickle cell disease and the kidney

About 1 or 2 out of every 20 patients with sickle cell disease will develop problems with decreased kidney function. The number of patients with sickle cell disease and kidney problems increases with age and among sicklers alive and over the age of 45, 6 out of 10 of them will have kidney problems requiring medical attention. However, only 1-5 out of 20 sickle cell patients with kidney disease will go on to develop kidney failure requiring dialysis or kidney transplantation.

Problems with the kidney due to sickle cell disease is usually due to sickling in the small blood vessels of the kidney. The beginning of kidney problems in patients with sickle cell disease is usually quiet starting between the ages of 10 and 20 without symptoms. This symptom free stage is however progressive and requires close attention by doctors to detect early.

The most common signs of kidney disease in sickle cell patients is-

- Frequent urination and increased volume of urine. Noticed even in the first 10 years of life and is just another reason for sicklers to always remain well hydrated and drink sufficient amounts of water

- The presence of protein in the urine,

- The presence of blood even in microscopic amounts in the urine

- The development of high blood pressure and

- Worsening anemia.

The presence of any of these problems in a sickler should push the patient and doctor to pay close attention to kidney function in order to prevent progression to kidney failure. Majority of patients with sickle cell disease and kidney failure present between the ages of 20 and 40 years and these patients often are dead within 4 years of diagnosis of kidney failure.

It may appear that the number of people with sickle cell disease and kidney disease is low. However kidney failure is clearly an identified risk for death among sicklers so it is important to prevent kidney disease due to sickle cell anemia and control of kidney disease in those who already have poor kidney function is important.

It is equally important to note that not all kidney disease in patients with sickle cell anemia is due to sickle cell disease. Other causes of kidney disease in these patients might include lupus, or infection with hepatitis B, Hepatitis C or HIV. These infections are common infections among Nigerian sickle cell patients because of all the blood transfusions they often need over time that puts them at increased risk for acquiring the infections.

For more information on the concerns about blood transfusion and how they may be of importance to sickle cell patients, read our recent blog post about these infections by clicking http://kidneysolutions./2014/03/28/viral-infections-in-kidney-disease-and-dialysis-patients-in-nigeria-truths-myths-and-what-to-do/.

Sickle cell disease patients also appear to be at increased risk for medullary cancer of the kidney. This often presents with abdominal pain, a swelling in the abdomen, blood in the urine and weight loss. Any sickle cell patient with these symptoms must discuss immediately with their doctor.

What to do to prevent or control kidney disease and symptoms in sickle cell patients.

(Please note that these recommendations are only good practices to help empower patients with sickle cell disease. They do not replace the need to see a trained medical professional for detailed proposals for treatment and follow up.)
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- Be vigilant for signs and symptoms of kidney disease such as increasing blood pressure and blood in the urine.
- Visit your doctor regularly and ask for a kidney check up with blood and urine tests.
- Drink plenty of water
- Pay attention to controlling blood pressure.
- Make sure as a sickler you get vaccinated against common infections. Fevers and infections are dealt with as quickly as possible by seeing a doctor.
- If you already have some kidney disease as a sickler make sure you are seen from time to time by a kidney specialist
- Talk to your doctor about medications like EPO, iron and vitamins you can take to increase blood production and decrease the need or frequency of blood transfusions.

IMPORTANT LINKS FOR PATIENTS WITH SICKLE CELL DISEASE
The sickle cell foundation of Nigeria. http://www.sicklecellfoundation.com/
World Health Organization Fact sheet on sickle cell disease. http://www.who.int/mediacentre/factsheets/fs308/en/

This is a brief summary of an earlier blog post on the KidneySolutions blog page. For more information on the topic, visit, the blog post at http://kidneysolutions./2014/04/13/upcoming-blog-post-may-2014-environmental-causes-of-kidney-disease-and-failure-in-nigeria-a-big-public-health-problem/

For more information on Kidney disease, dialysis or kidney transplantation, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page at https://www.youtube.com/user/KidneySolutions1 for lots of educational information. You can also send email to- [email]info@kidney-solutions.com[/email].

Summary: Many people think of kidney disease and think of more commonly publicized medical causes such as high blood pressure, diabetes or inherited disorders such as polycystic kidney disease. However, it is important to know that there are a group of causes of kidney disease and kidney failure that are likely under recognized by the public, under diagnosed by doctors and most likely, a bigger public health problem than currently appreciated. These under recognized causes are toxins and other exposures in the natural and occupational environment. These exposures may occur through what we eat, drink, breath or put on our skin knowingly or unknowingly. An appreciation of these causes of kidney disease along with the more commonly known causes is important to enable early identification and management before kidney impairment becomes advanced and irreversible.

The causes of kidney disease and kidney failure in Nigeria that are related to occupational and environmental exposures have not been fully established but of those identified, there are a broad range that include,

Expired drugs:
A commonly overlooked and easily preventable cause of kidney disease is kidney disease due to exposure to expired drugs. One of the most commonly implicated medications that cause kidney disease when expired are the tetracycline family of drugs. When expired, tetracyclines breakdown and produce chemicals that are toxic to the kidney and make it malfunction.
In general, if the color, taste or smell of a drug has changed, if a medication has been in an open, warm and damp place for a long time or if the label shows the medication has expired, THROW the medication away and get a new prescription.

Heavy metal poisoning:
This is an under recognized occupational and environmental hazard that has certainly been associated with kidney disease. Lead that is contained in petrol, paints and batteries over even a few years can accumulate to high levels in the body and cause several problems ranging from nerve damage to kidney damage. Lead exposure is also common among people that work in precious metal mines such as gold mines. Artisanal miners extract the gold from lead-rich ores, many grinding them in flour mills, which creates lead dust. The gold and lead laden dust then mixes with the soil and increased levels of lead have then been identified local foods grown in the area of such activity. Adding to the concern, miners also use mercury, another contaminant harmful to the kidney, to bind with the gold and increase mining yields. For a report on the documented risk of exposure to lead and other heavy metal poisonings due to pollution that are capable of causing kidney failure in Nigeria, read the an excellent article by Galadima and Garba from the Ahmadu Bello University in Nigeria http://www.abu.edu.ng/publications/2012-08-30-153323_5321.pdf.

Excessive amounts of copper and chromium have also been clearly implicated as causes of kidney disease. The leather tanning and processing business in the norther parts of Nigeria has been identified as a source of such heavy metal exposure. The waste water used in processing the leather skins is known to contain levels of copper, chromium and other metals well in excess of toxic levels and the sludge or waste water is commonly drained and spread on soils including farmlands. The heavy metals then can also leach into sources of water used for farming, drinking, washing and bathing. Indeed elevated levels of copper and other toxic substances have been found in rice and other cereals in leather tanning areas as documented in this report by Tudunwada, Essiet and Mohammed http://www.notulaebotanicae.ro/index.php/nbha/article/viewFile/214/211.

When acidic foods are cooked in unlined copper cookware, or in lined cookware where the lining has worn through, toxic amounts of copper can leach into the foods being cooked. This effect is exacerbated if the copper in the pots and pans has corroded, creating reactive copper salts. Actual cooking may not be required for copper to leach into acidic liquids if they are stored in copper for a period of time. Many countries prohibit or restrict the sale of unlined copper cookware. Copper oxide glaze on cups used for hot liquid might also be a concern, as well as copper pipes for conveying water to the home.

Mercury exposure may also go unrecognized in people who use mercury containing skin lightening/bleaching products. In the United States and Europe, mercury containing cosmetics are no longer permitted for sale but a number of such products are still widely available and sold in Nigeria. In one survey, up to 77% of Nigerian women reported use of a skin lightening product regularly. The recommendation is to always carefully look at the ingredients for cosmetics and avoid purchase of mercury containing products. For more information on the magnitude of the problem of mercury in cosmetics, read a World Health Organization report that covers the issues in Nigeria as well http://www.who.int/ipcs/assessment/public_health/mercury_flyer.pdf?ua=1.

Snake and insect bites:
While venomous snake and insect bites are easily recognized, they may not be as readily identified as causes of kidney disease usually presenting in the form of acute kidney failure. The poisons (venom) from snakes and insects that cause kidney failure usually do not have a direct effect on the kidney but an indirect one though toxic effect on the muscle and red blood cells where heme pigment in the form of myoglobin or hemoglobin can be released in massive amounts and cause toxic damage to the kidneys. The treatment for kidney failure due to snake and insect bites is usually supportive in nature and focused on maintaining blood pressure, flushing the kidneys and making as soluble as possible any other substances such as hemoglobin or myoglobin so that they are not as toxic to the kidneys. Anti-venom medications are not widely available in Nigeria and even where available often are specific to a specific kind of snake or insect bite. An interesting paper on the epidemiology and management of snake related bites in Nigeria is published by A. Habib from the Bayero University in Kano and can be accessed http://www.jvat.org/content/19/1/27.



Traditional herbal medications.
Not all herbal medications are harmful and a number are clearly beneficial in some circumstances. However, a number of herbal remedies including mushrooms contain certain poisonous chemicals and in the wrong clinical circumstance can cause or worsen kidney diseaseeven irreversibly. Kadiri and colleages in a paper published in the African Journal of medical sciences over 20 years ago estimated that traditional herbal remedies were responsible for about 1 in every 3 cases of sudden kidney failure presenting to the University College hospital Ibadan (access link to abstract of paper http://www.ncbi.nlm.nih.gov/pubmed/?term=Nigeria+AND+acute+kidney+injury+AND+traditional+herbal+remedies). A paper by A. Mustapha from Nassarawa state university (access http://www.jnronline.com/index.php/jnr/article/viewFile/38433/30681) showed how commonly used one of many traditional herbs are and likely reasons for such even though the hazards were not discussed.

The kidneys are especially vulnerable to the side effects of such toxins from traditional herbal medicines because of the large blood supply to the kidneys. For example a number of traditional herbal medicines in African contain Securidaca longepedunculata (containing saponin and methylsalicylate), Euphoria matabelensis (containing latex), Crotalaria laburnifolia (contains hepatonephrotoxic alkaloids), Callilepsis lauereola or Cape aloes. Securidaca longepedunculata (violet tree) for instance is commonly found in Nigerian herbal mixtures and has been used for the treatment of numerous ailments ranging from abortion, cough and pneumonia to protection from withcraft, “sexual boosting” and tooth aches. A mushroom called Amanita smithiana contains an acid that can cause kidney damage within hours. This mushroom has on occasion been mistaken as an edible mushroom and caused trouble for the unsuspecting recipient. What is under appreciated with herbs like this and the others mentioned is that in many circumstances they cause sudden kidney cell death or raise blood pressure.

Paraquat:
Is a common component of pesticides used in farms in Nigeria and other developing countries. It is a known environmental cause of sudden kidney failure and know to even cause death. For access to a full length paper describing paraquat toxicity and its mode of action in some commonly consumed vegetables in Abeokuta, Nigeria, click [url]http://www.academicjournals.org/article/article1380032321_Akinloye%20et%20al..pdf[/url]. A paper reporting a 5 years experience of of a local hospital in India (access http://medind.nic.in/iav/t03/i2/iavt03i2p64.pdf) reported kidney failure as the most common feature of paraquat poisoning as well.

Conclusions
This is by no means meant to be an exhaustive discussion of these environmental hazards with an impact on the kidney. The post is meant to raise awareness of the rather common environmental exposures we all may be unaware of that can lead to significant problems for individuals, their families and the community. Nothing substitutes for attention to what we eat, drink, breath or put on our skin and advocacy for strict regulation by the health authorities where possible is important.

This is a brief summary of an earlier blog post on the KidneySolutions blog page. For more information on the topic, visit, the blog post at http://kidneysolutions./2014/01/15/transplant-101-what-you-need-to-know-as-a-transplant-patient-in-nigeria/.

For more information on Kidney disease, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page at https://www.youtube.com/user/KidneySolutions1 for lots of educational information. You can also send email to- [email]info@kidney-solutions.com[/email].

Summary: There are two options for patients diagnosed with end stage kidney disease- dialysis or kidney transplantation. Kidney transplantation is the best option for patients. However, kidney transplantation requires a knowledgable patient, a medical team that knows what they are doing. Many patients get transplanted outside the country but dont have the right plans before or after the transplant to ensure the transplanted kidney lasts a long time. This post provides a brief summary of some the things needed for transplant patients to be successful.

At the present time, if patient’s original kidneys fail, there is no known way to regenerate them and artificial kidneys are not yet available, so the only treatment options are dialysis and kidney transplantation. Kidney transplantation is currently the optimal treatment for kidney failure for patients that qualify. Most patients can live long and productive lives with a kidney transplant similar to that of people without kidney failure if they are careful, take their medications as prescribed, have experienced kidney specialists and perform the required routine testing. To have the best chances of success, take your time to find kidney doctors near you with experience taking care of transplant patients. Not all kidney doctors know how to take care of transplant patients..

Your kidney doctor will have to perform a number of tests to make sure it is safe for you to perform the transplant surgery and ensure the cause of your original kidney disease does not happen again and destroy the transplant kidney. The testing is also needed to determine the best treatment plan to reduce the risk of transplant kidney rejection or other complications such as infections, poor wound healing and cancers.

The steps leading to a successful kidney transplant are

1. Understand the particular cause of kidney failure in your case from a kidney doctor/specialist and find a blood group compatible donor

It is important to know the cause of kidney failure as some of the causes of kidney failure can affect the transplant kidney and destroy it. Your doctor may want to treat the cause of kidney failure and stabilise it before recommending proceeding with transplant.

While these evaluations are going on, you need to look for a donor. In Nigeria, there is no option for a donor kidney from someone who has died as such are not yet legally allowed. So the only option is to get one from a living person who agrees to donate the kidney. Speak to family and friends about your condition. Let them know your increased risk of death and how difficult life is especially if you are on dialysis. These discussions can be difficult because you may be worried about being turned down. If this is the case and you have family or friends interested in learning more but not sure if they want to proceed, ask them to talk to your kidney doctor to discuss the risk and benefits involved in kidney donation. The best donor is from a healthy living person between the ages of 25 and 50 of the same blood group as you with no medical problems. It is important to know that the donor does not need to be related to the recipient.

2. Work up or clinical testing for recipient and donor – reduce risk of bad outcome for recipient and donor.

Transplantation and the surgery involved can be stressful to the body and carry a risk of severe injury or even death. To avoid these complications, your doctor will have to perform tests on your heart, lungs, blood and blood vessels to make sure you can handle the stress of transplantation. You will also need to be tested for certain infections or cancers because transplant medications that prevent rejection of the transplanted kidney also weaken the immune system that protects against infection and cancer. Part of preparation for transplant may involve getting vaccines against infections such as hepatitis B.

Your donor also needs testing done. This is to ensure the donor is healthy, can stand the stress of surgery and does not have silent kidney disease or conditions that can cause kidney disease as well. Testing is also necessary to ensure that the donor does not transmit infections or cancers to the recipient. Special testing also needs to be done to ensure the donor and recipient are compatible and help the surgeons know which kidney to take out of the donor and how best to take it out. Some transplant centers require that a donor be related to the recipient while other transplant centers do not insist on such a relationship.

3. Find expert center for transplant and discuss risks and complications

While cost is an important consideration in selecting a transplant center, it is most important to find a center with specialist doctors and experts that know what they are doing. Ask questions of the doctors of their experience taking care of transplant patients, speak to transplant patients and learn about their experiences. Take your time and don’t rush the process. It is an important decision and could be a matter of life and death or a short bad experience only leading you back to dialysis.

At the present time, there are a few centers in Nigeria that perform the surgery. However, there are a few centers that have specialists that can help you prepare properly for transplantation outside the country. There are also experienced centers outside Nigeria in India, the United States and United Kingdom where kidney transplantation can be performed. Wherever you decide to have your transplant, you must ask questions and get a good understanding of their experience and capabilities to provide excellent care to you and your donor.

Life after transplant- doctors visits, medications, testing, etc

Immediately after discharge from the hospital after a transplant, you would have to see your doctors at least once or twice a week for the first 4-6 weeks. If there are complications, you may need to be seen more frequently. Each visit will almost alway be accompanied by tests which may be even be requested shortly in advance of the visit so the doctor has real time information on the function of the kidney. Then onwards, the frequency of the visits become less frequent. By the time you hit the 6 month time point, you probably are seeing your doctor only once a month even though you may be doing lab tests twice a month. Your schedule of clinic visits and blood testing after the 6 month time point will depend on your doctor. It is important that you keep these appointments and do the required testing as they are the only opportunities to identify problems early before they become big issues. IF YOU LIVE IN NIGERIA, LOOK FOR A DOCTOR THAT KNOWS HOW TO LOOK AFTER KIDNEY TRANSPLANT PATIENTS WHEN YOU RETURN FROM THE TRANSPLANT SURGERY ABROAD! DO NOT DEPEND ON YOUR DOCTOR ABROAD AS THERE IS NO WAY THEY CAN OR ARE REALLY INTERESTED IN CARING FOR YOU AT THAT POINT. LOOK FOR A GOOD KIDNEY TRANSPLANT DOCTOR EVEN BEFORE YOU GO FOR TE TRANSPLANT BECAUSE THE HARD PART IS KEEPING THE KIDNEY WORKING WELL FOR YEARS AFTER THE INITIAL SURGERY. REMEMBER, NOT ALL KIDNEY SPECIALISTS KNOW HOW TO CARE FOR KIDNEY TRANSPLANT PATIENTS.

You will be on several medications after your transplant. ALL these medications are important. Some are for preventing rejection, some are for preventing dangerous infections due to the rejection medicine. Some patients may continue to need medication for high blood pressure but many will be able to reduce or completely stop medications for high blood pressure. Initially you may also continue to need EPO for low blood levels (anemia) for some weeks to months till your transplant kidney is working well enough. If you were diabetic before the transplant and on insulin, you may notice that your insulin requirements even go up as the new transplant kidney starts “eating up” some of the insulin. Some of the rejection medicine may also have side effects such a headaches, nausea, vomiting, shaking of the hands, diarrhoea, bone pain, pins and needle sensations in the hands and feet, gout, or even cause high cholesterol or high blood sugar. Some patients that were not diabetic before transplant might become diabetic because of the transplant medication. You transplant doctor will help you control the new onset diabetes.

If you have any of side effects from your medications, you must tell your kidney doctor as soon as possible so that careful changes can be made. NEVER change or stop your medication on your own as this can affect you or your transplant kidney. NEVER start new medicine without your kidney doctor knowing either. Certainly do not take any herbal medicines.

Many patients are able to return to a high level of functioning after kidney transplantation. Returning to work is possible but depends on a lot of things. It depends on how sick you were before the transplant, if there were serious complications during or after the transplant and how well the kidney transplant is working. Those with simple jobs like working behind a desk can probably return to work before a person that has a physically demanding job. Talk to your kidney specialist about going back to work and the best time to do so.

Do’s and Dont’s

- You must take your medications every day as prescribed. You can not forget to take any medications

- Do not believe anyone who tells you that you do not need to follow up regularly with your doctor after a kidney transplant. You may get away with no problems for a while but you eventually will pay a heavy and unnecessary price with the kidney failing before it should or having a serious problem that could have been prevented with close follow up. Without proper follow up, you could die, get a serious complication or end up back on dialysis.

- Do your routine testing. Sometimes it is the only way to identify a problem when it can be managed easily and cheaply. Routine testing is necessary and important to prolong the life of your kidney. A number of patients have had their transplant kidney function well for up to 30-40 years. This was only because they took really good care of the kidney and kept all their appointments and checkups.

- Don’t treat malaria without letting your transplant doctor know. Some malaria medications may reduce the level of your transplant medication in the blood and put you at risk of rejecting the transplant kidney.

- Do not take grapefruit or grapefruit juice as a transplant patient. It can affect the levels of transplant medications and increase the risk of rejection.

- If you have a fever, do not ignore it or self treat. Talk to your transplant doctor immediately. It could be a sign of a serious problem that threatens your life or your transplant.

It is important to know that transplantation in Nigeria presents a unique and challenging circumstance that patients need to be aware .

First of all, not all patients with kidney failure are candidates for kidney transplantation. It may therefore mean that certain patients will never be suitable candidates for transplant and need to continue on dialysis while some with the right medical advice and treatment may eventually become candidates for transplantation.

Patients above 70 years of age, patients with active infections such as tuberculosis, HIV, Hepatitis B or Hepatitis C, patients with certain parasite infestations, patients with active heart or vascular disease or patients with certain cancers are considered poor candidates transplant. Patients without adequate family or social support are not candidates either for transplant as there are a lot of demands before, during and after transplant that most if not all patients can not deal with on their own. Other reasons for not being a transplant candidate may be that the surgery might be too stressful for patients with bad heart or blood vessel disease and lead to death during or shortly after surgery. In addition medications for preventing rejection could worsen existing infections or cancers.

So before rushing for a transplant, speak to a kidney specialist or transplant doctor. The kidney specialist will help you decide if transplant is a safe option for you. For some patients, it may be safer to proceed with dialysis.

Secondly, transplantation is worth it but is not cheap and despite the success in many patients it is never 100% certain it will work out easily without costly complications. Also, remember that the kidney transplant may fail and you may need to return to dialysis. The good news is that the cost of transplant is cheaper than dialysis after a few years. The current cost of performing an uncomplicated transplant ranges from 3-6 million Naira in Nigeria to 4-7 million in India, to 10-15 million Naira in the US or UK. If there are complications, the costs are higher. The medications to be taken after transplant to prevent rejection or infections can cost as much as 50,000 to 100,000 Naira per month. In addition, monthly testing to check on the level of transplant drugs may cost another 20,000 to 50,000 per month. As far as lab testing is concerned, some of the tests such as transplant drug levels or immune testing need to be performed outside Nigeria such as in South Africa or the UK and drive the cost of testing up. Hopefully, these tests become available locally soon at cheaper rates.

Patients need to have these costs in mind and compare them to the costs of a years worth of sufficient dialysis (3 times a week) that comes to about 5 million Naira per year. This compares to the initial cost of surgery (4-10 million Naira) and then the yearly cost of drugs and testing of about 2 million Naira. Therefore by the beginning of the 3rd to 4th year after transplantation it is cheaper to have a transplant than to remain on dialysis. The reasonable concern with transplant is the huge initial costs.

Thirdly, many patients have trouble finding a donor kidney. There is currently no option of getting a kidney from a dead person as there are not yet any laws in Nigeria to govern or control the use of organs from deceased people. Therefore, the most viable and legal option for obtaining a donor kidney is from a living donor. This person can be related or non related to the potential recipient although it should be noted that many transplant centers do not perform transplant from unrelated donors. The donor as mentioned earlier has to be tested or checked properly before surgery.

Getting a kidney from a living donor is also the best option for the recipient as it will last longer and work better if put in properly and taken good care of. Some patients and their families may have concerns that it is religiously unacceptable to get a kidney transplant. The Catholic and Anglican Church, the major Islamic bodies and Jehovas Witness church have approved kidney transplantation from either cadaver or living donors. In the case of Jehovas witnesses, the organ is purged/flushed of all blood and transplantation without blood transfusion while risky is possible.

To summarize, getting a kidney transplant is the best option for kidney failure. It is a complicated process and demands sufficient finances, an experienced set of doctors, a supportive family and an informed patient that follows all recommended follow up instructions for the best results.

If you have any questions about kidney transplantation in Nigeria feel free to contact us at info@kidney-solutions.com

This is an abbreviated version of a full blog post on the KidneySolutions blog page.
For a detailed review of the topic go to http://kidneysolutions./2013/12/16/quality-and-clinical-performance-measures-in-kidney-disease-and-dialysis-care-in-nigeria/
For more information on Kidney disease, you can also visit the KidneySolutions website at http://www.kidney-solutions.com/ or the KidneySolutions YouTube page for lots of educational information. You can also send email to- [email]info@kidney-solutions.com[/email]

Summary: There is a growing epidemic of kidney disease and kidney failure happening in Nigeria. Lots of lives and resources are being spent by individuals to get the best care they need but many are taking advantage of the difficult circumstances of patients and offering care that is far below standards. What should patients, doctors, health insurance providers and the government expect from providers of such care? This post tries to provide some insights.


The kidneys are important organs with the important function of removing waste products and toxins from the body. These wastes and toxins are filtered out into the urine. The kidney also is important for the regulation of blood pressure and for creating the signals to the bone to create blood.

Kidney disease is a condition where the functions of the kidneys are lost. Sometimes the loss of function of the kidney is temporary. On other occasions it is permanent or progressive leading eventually to kidney failure requiring dialysis or kidney transplantation to sustain life. It is estimated that some 15-20 million Nigerians to have some form of kidney disease and about 100-500 of every million Nigerians have advanced end stage kidney failure requiring dialysis or kidney transplantation. In some studies, 1 in every 10 hospital admissions have been associated with kidney failure requiring dialysis in Nigeria.

The most common causes of kidney disease in Nigeria are diabetes mellitus, hypertension, infections , glomerulonephritis and toxin exposure from herbal medications or poorly manufactured or expired drugs. Therefore, if you are over the age of 40, or have a personal history of diabetes or hypertension or a family history of kidney disease, you should ask your doctor to perform simple tests to detect kidney disease early. There are means available to hopefully prevent or delay kidney failure. Your doctor can also help you treat the cause of your kidney disease.

Treatment of kidney disease can be expensive if it is not detected early or managed by competent professionals. Not all healthcare providers or medical centers are equipped to deal with this disease so persons with kidney disease must know what is important in identifying centers that can provide high quality care. It is very important to know that most cases of kidney disease can be prevented with much less cost impact if efforts are made to regularly visit a doctor at least once a year to improve abnormalities such as high blood sugar, high blood pressure - the most common causes of kidney failure in Nigeria.

An important question for any reader of this post is “how should I look at the information presented in this post?” Well the answer lies in the reason for reading the post in the first place, which in turn defines the position of the reader as a stakeholder. The questions from a patient, their family and friends would and should come from a different stake holder viewpoint than a health policy maker, a health insurance provider responsible for paying for kidney disease and dialysis care or the providers that include both the kidney specialists and general practitioners directly or indirectly involved in the provision of the care.

For example

- A patient and their family might focus on quality and clinical performance measures that support a medical centers claim that they will deliver on the promise of preventing death and improving quality of life.
- A policy maker or regulator or government while also interested in outcomes of death and quality of life would also focus on quality and performance standards that require governmental oversight or incentives.
- A health insurance provider may ask questions focusing on a centers process of care that decreases the incidence of poor outcomes and minimizes costs of clinical outcomes of kidney disease such as catheter infections or hospitalizations due to stroke, heart failure and heart attacks. Health insurance providers are likely also interested in clear metrics of performance and quality that can be applied across the industry.
- A provider may be interested in knowing the core quality and clinical performance measures necessary to improve patient and payor satisfaction and gain an edge over competitors.

Let us identify what quality and clinical performance measures are important in the delivery of effective kidney disease and dialysis care. These measures are best broken down into three categories based on the structure, process and outcome framework proposed by Donabedian.

The Structure of kidney care services refers to the components of the healthcare system. It is important that any kidney care center has the proper structures in place to deliver high quality care. Aspects of the structure of care for a kidney disease center should include-

- Adequacy of equipment and resources both for routine and emergency diagnosis and treatment of kidney diseases
- Administrative and organizational features of a clinic to efficiently mobilize resources for patient care. For example
What is the pre-treatment triage for dialysis patients to determine the best environment for care. Some dialysis patients who are critically ill are best cared for in an intensive care unit, while others who are more stable can be cared for in an outpatient center. Care in an intensive care unit is more expensive but only because more complicated cases are dealt with there.
- Dialysis machine/water treatment system operation and disinfection protocols to ensure safe and timely delivery of treatment. This is probably one of the most important issues because many patients have compounded problems when they are exposed to hundreds of liters of water for dialysis that is not ultra-pure.
- Systems to ensure patient education. Patients should be educated on what to do at the earliest signs of kidney disease when kidney disease is easier and cheaper to deal with and not ignored till it is too late and requires more expensive treatment such a dialysis or transplantation.
- The resources and plans in place to ensure adequate physician, nurse and technician training and oversight
- The resources, plans and administrative plans in place to ensure regulatory compliance. In this regard, national bodies such as the Medical and dental council of Nigeria with recommendations from the Nigerian Association of Nephrology should ensure that every registered kidney disease and dialysis center meets standards for quality. Professionals that know something about kidney disease and dialysis care should be on monitoring and approval teams to ensure that mediocre centers are not permitted to operate.

The Process of care refers to the use of appropriate diagnostic and therapeutic modalities for the individual patient

- Order entry and prescriptions
This includes plans and resources in place to ensure that the assessment of proteinuria, estimating the level of kidney function, prescribing kidney protective medications, correctly identifying threshold and timing of referral to a kidney specialist, evaluating abnormalities of mineral metabolism or evaluation by a surgeon for vascular access for dialysis is done in a timely manner.

- Documentation and health care privacy compliance or Informed consent, patient record safety and privacy
- Patient care including the procedures and protocols in place for routine and emergency care
- Patient education on their disease, treatment options, dialysis access , dialysis adequacy and diet, Transplantation education and care.

The Outcomes of care for kidney disease refer to the consequences of treatment and can represent markers of disease progression, health status or cost.

Examples of key outcomes of care for kidney disease include

- Proportion of patients in a program with adequate blood pressure, blood glucose and anemia control. All patients should be able to ask their doctor about the quality of control of these parameters. Health insurance providers should also have confidence that centers are keeping these parameters under control.
- Proportion of dialysis patients who started long-term dialysis in an emergency situation

Examples of key outcomes of dialysis care include

- Catheter infection rates
- Rates at which patients get dialysis with a groin catheter.
- The proportion of dialysis patients at a center with a fistula or graft instead of a dialysis catheter,
- Admission/Hospitalization rates for complications of kidney failure such as heart failure
- Death rates
- Dialysis dose goal achievement. Many patients need to know that at every treatment, they need to achieve a urea reduction ratio (URR) of at least 65% or what is called a Kt/V of 1.2. In the Nigerian context, many patients do not come as regularly as 3 times a week for reasons primarily related to out-of-pocket costs of care. Nevertheless, centers should be able to provide patients whenever they come in for treatment with a dialysis dose Kt/V of approximately 1.2 at each treatment. Modern dialysis machines have online monitoring systems that permit the doctor and dialysis nurse to make adjustments in real-time to achieve this goal with every treatment.

- Proportion of patients with moderate and severe anemia
- Proportion of patients with adequate blood pressure control

To conclude this discussion, It is important for all stakeholders, especially healthcare providers to realize that clinical practice guidelines while important in improving the quality of care are not quality and clinical performance measures. Guidelines for care are written to suggest diagnostic and treatment approaches for most patients most of the time. They do not however set the standards to which the quality of care and patient outcomes should be measured.

The issue of quality in Nigerian healthcare is a growing topic of interest and discussion. As Nigerian we should demand highest quality of care and encourage those who provide such and punish centers that provide poor quality care. All stakeholders are demanding for more but it is important that they know what to ask for. For additional reading on the greater issue of healthcare quality especially from a patient perspective, the reader is referred to a recent blog post by Dr Uche Ofoma on the Nigeria Health Blog at http://www.healthblogng.com/rating-nigerian-hospitals/#more-671