Kidney transplant saves life, dialysis only prolongs

Geoffrey Chege's eyes shone with hope as he narrated his 10-year journey in search of a possible solution to a total kidney failure traced to blood pressure.

In 2011, when laboratory tests pointed to failure of blood arteries, almost immediately, other medical results showed that his kidneys were shutting out. He quickly embarked on dialysis through advise from family members. It was a procedure that cost him Sh500, 000 twice a week.

“My journey started 10 years ago, when I was diagnosed with High Blood Pressure, and chronic Glomerulonephritis. I had not been receiving quality services, so after 10 years my kidney failed completely," he said recently at Mediheal Hospital where the institution hosted a ceremony to celebrate some successive kidney transplant procedures. 

His hope of survival was re-engineered early this year when a friend informed him about the hospital and its surgery programmes.

“But once I was directed to Mediheal hospital, I was advised by Dr. Bag to go for a transplant, which was done successfully, and now I am back at work,” he recalls.

He called on Kenyans to embrace organ donation, in order to help patients requiring kidney remedies. Chege noted that patients who need the organs know the importance.

“I was on a weekly dialysis programme which I had to attend twice. It is painful and tiresome. I could wake up at 6am; queue for the machine and take close to five hours of the whole procedure, after that I will be so tired,” he added.

The police officer is almost on permanent immune-suppressant medicine, to avoid rejection of his new kidney.

With reference to Chege's disease journey, experts are calling on patients who have been diagnosed with kidney disorders – especially during this Covid-19 pandemic period - to seek transplant services rather than going for dialysis, so far, a mere life-extending treatment. This is if the disease had progressed.

Experts are arguing that kidney transplant helps a patient to feel better and increases chances of a longer lifespan as it can be used to treat a chronic kidney disease or end-stage renal ailment.

Dr. Sananda Bag, a kidney transplant expert with the Mediheal Group of Hospitals is saying that the Covid-19 pandemic has already exposed kidney patients to greater pain and uncertainty. This, he noted, is because most of the patients on dialysis spend more time in health facilities where the risk of Coronavirus infection is high.

“What we have noted that not only is the Covid-19 pandemic an ongoing; evolving threat, which has put people with End-Stage Renal Disease (ESRD) at great risk as they congregate in dialysis centres, but also seen data suggesting that an average of 30 percent of people who are recuperating in Intensive Care Units sustaining kidney damage from the virus,” Bag said in the weekend when the hospital celebrated over 150 successful kidney transplants in the last two years.

While recommending patients with diagnosed kidney failures to go for transplant - as the safest treatment – Bag said of the 152 transplants that had been done by the hospital, 72 were successfully carried out during the ongoing Covid-19 pandemic.

“Using state of the art facilities which included special anaesthesia done to diagnose and operate on high risk patients, we recorded over 90 percent success rate for the patients. Of these patients, we operated on children and people living with HIV,” he added.

Some statistics show that the country has an estimated 50, 000 kidney patients that are on dialysis.

Bag said between 10-14 percent, about 5.2 million to 7.3 million out of 52 million people are at high risk of kidney failure.

“People are not aware that transplant is good and beneficial to great health and economic outcomes. Data shows us that more than 25-50 percent of patients on dialysis are not likely to survive, but 90 percent of those who undergo transplant, survive.

“Compared with dialysis, kidney transplant is associated with better quality of life,” he added.

It is emerging that patients on dialysis require not just breathing support but also renal replacement therapy for their damaged kidney. This has left many health facilities in a compromised healthcare system like the one in Kenya at a greater strain with insufficient dialysis equipment and trained staff.

John, as he prefers to be identified, is caring for a patient enlisted for dialysis twice a week. This is just to prolong her life. Besides, the time he spends taking the patient to hospital, John is required to cough up to Sh67, 000 just for tests and drugs. “It’s a monstrous journey we never envisaged,” those were the only words he was able to say when approached by People Daily yesterday to talk about his life with a patient who has renal challenges.

Yesterday, County Executive Committee Members (CECM) of health caucus chairman, Dr. Joseph Mbai said it is increasingly becoming urgent that long term solutions to kidney ailments are enhanced to reduce the burden of this particular non-communicable disease (NCD) on patients.

Mbai, the Murang’a CEC for Health concurred with expert findings that dialysis should be replaced with better treatment options for kidney failure, and transplant present the solution needed.

“Whereas, dialysis happens to be the most preferable point of entry treatment for most of the patients battling ESRD, on the other hand, it’s not the best option. Number one, it’s costly, tiresome and time consuming. Number two, it’s just a life prolonging type of intervention,” Mbai said.

However, he pointed out that recent studies have shown that patients who are at an advanced stage of renal failure can opt for transplant, which with the right medication will lead to healing of a patient.

“Dialysis can only prolong a patient’s life for up to 15 years, but with quality medication and a marching donor for transplantation, people with ESRD can find remedy and thereafter lead a quality life,” he added.

Health Chief administrative Secretary, Dr. Mercy Mwangangi said that Chronic Kidney Disease (CKD) is a key determinant of the poor health outcomes of major NCDs.

“When you look at the burden of NCDs, you will see that approximately 39 percent of deaths of people, who die in the country, are attributed to NCDs, and it is something that we need to pay attention to,” the CAS said yesterday after launching the National Strategic Plan for the Prevention and Control of NCDs.

Approximately 39 percent of deaths in the country were as a result of NCDs; up from 27 percent in 2014. It is projected that deaths from NCDs will increase by 55% while those from injuries will increase by 25 percent by 2030.

The Lancet Report published in April 2020, it shows that the total costs of providing haemodialysis in Kenya would be in the range of Sh170 billion (USD1·7 billion) annually.

“The COVID pandemic is revealing, in painful relief, the cracks in our health care system and placing those with kidney disease at even greater risk. To protect them now and in the future, we can learn from innovative approaches. Doing so can save lives and money.

“The majority of the potential savings from improving Chronic kidney disease (CKD) care are likely to come from coordinating care, offering patients support, and delaying disease progression,” says Brian Brady, a Stanford University nephrologist published in April last year.

The challenges for patients seeking dialysis, Bag underscored, are immense. They range from finding safe transportation and ways of separating them from those who test positive for COVID-19 to procuring personal protective equipment and dialysing solutions, which are in increasingly short supply.

“Many patients only discover they have the condition when their kidneys fail with a staggering number of those beginning dialysis across the globe,” he added.

Other estimates show that these incidents occur almost uniformly across the world, indicating that  the estimated number is between 23 percent to 38 percent.

“It is even more problematic in the COVID-19 era, when hospitals confront shortages of dialysis equipment and ICU beds,” he said.

Bag said 70-75 percent of kidney failures are caused by uncontrolled diabetes and high blood pressure.

Data shows that there is a 5-10 percent kidney rejection rate.