FACULTY OF CLINICAL SCIENCES

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    Challenges and possible solutions to peritoneal dialysis use in Nigeria.
    (2020) Ajayi, S.; Raji, Y.; Bello, T.; Arije, A.
    Introduction: peritoneal dialysis is a form of renal replacement therapy that is both effective and relatively affordable. Peritoneal dialysis (PD) was first used in Nigeria as a treatment option for renal failure. Its use was first reported in Nigeria in 1969 and became more widespread in the 80s and 90s. Haemodialysis, which is capital intensive to set up and requires infrastructures and facilities such as electricity, intense water consumption and buildings, seems to have upstaged peritoneal dialysis both in demand and supply. Methods: this cross-sectional study is a convenient survey of nephrologists, renal technicians and nurses in Nigeria. We used a structured, self-administered questionnaire on a cross-section of members and associate members attending a national nephrology association meeting. Results: there were 68(54.4%) doctors, 43(27.2%) nurses, and 14(11.2%) renal technicians, all from medical institutions with renal treatment programs who participated in the study. The most common problems encountered with PD use are financial constraints (51.7%), inadequate fluid supply (50%), frequent line blockage (22.4%) and frequent infections (17.2%). Reasons attributed to the stoppage of PD in the centres included lack of PD fluids (50.8%), unavailability of PD catheters (22.8%), lack of expert personnel to train (15.8%). Conclusion: main challenges to peritoneal dialysis use in Nigeria include limited experience and training and availability and cost of consumables. Effort to overcome the factors militating against its use should be positively pursued so that peritoneal dialysis will be reintegrated into the mainstream of renal replacement therapy once more
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    Unaffordability of renal replacement therapy in Nigeria.
    (2016) Ajayi, S.O.; Raji, Y.; Bello, T.; Jinadu, L.; Salako, B.L.
    With the increase in epidemic proportions of diabetes worldwide, the number of patients who will require renal replacement therapy (RRT) will be a great challenge to the health infrastructures of developing countries such as Nigeria. Because those mostly affected are in the economically productive age group, a vicious circle is established whereby those who keep the economy going are the same people affected. Secondary and tertiary care of chronic kidney disease involving RRT would exact disproportionate toll on the income of patients in the developing world where patients pay out of pocket for their own care. Whilst there is an increase in the number of facilities offering RRT, there is no commensurate sustainability of care either by the patients themselves or even by the government. The level of unemployment is increasing. Kidney transplantation is out of reach in addition to the cost of post-transplant care, which includes hospitalization and immunosuppressive medications. Most of the endstage kidney disease patients who enlisted in our dialysis program were unable to get or sustain adequate hemodialysis. The data also showed that more men were dialyzed at our facilities over the period under review and the age distribution has not changed much over the decade. From this dismal picture in the last decade emerges a series of questions as to why this is so and what must be done to increase access to RRT. Prudent fund management and cost containment, local manufacture of dialysis materials and nongovernmental sources of funding are means of driving down the cost of dialysis. In countries where drugs and equipment for health services are locally manufactured, such as India and other countries, the cost of health care is more affordable than in countries such as Nigeria where these are imported.