Challenges of Management of Chronic Kidney Disease in a Single Centre in Southern Nigeria
Ekpenyong EE1, Ikpeme EE2 and Oloyede IP3*
1Lecturer One and Honourary Consultant, Department of Paediatrics, University of Uyo/University of Uyo Teaching Hospital, Uyo, Akwa Ibom State Nigeria
2Professor and Honourary Chief Consultant, Department of Paediatrics, University of Uyo/University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
3Senior Lecturer and Honourary Chief Consultant, Department of Paediatrics,
University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
*Corresponding Author: Oloyede IP, Senior Lecturer and Honourary Chief Consultant, Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria.
September 22, 2022; Published: October 13, 2022
Background: Chronic kidney disease (CKD) in children has an increasing incidence globally. Most children in developing countries present in End Stage Renal Disease (ESRD) where Renal Replacement Therapy (RRT) is required for survival. Late presentation, unavailability of donors and highly specialised teams for Renal transplantation, dialysis back up, poor physical and legal infrastructure and cultural bias against organ donation pose huge challenges to the management of CKD in Nigerian children.
Objectives: The aim is to highlight the challenges faced with the management of CKD in children in a tertiary centre in southern Nigeria.
Methods: A retrospective study in which data of all children managed for CKD in UUTH over a 10year period (January 2012- November 2021) was reviewed highlighting the stage of CKD at presentation and challenges encountered in the management of these patients.
Results: CKD accounted for 16% of the renal diseases (232) and 0.67% of all admissions (5787) into the children’s ward during the study period. Seventy nine percent of the patients presented in stage 5 of the disease. Sixty seven percent of the CKD patients Left Against Medical Advice (LAMA), while 23% died. None of the patients had adequate dialysis or regular monitoring of biochemical parameters due to poor finances. Renal biopsy was not carried out in any CKD patient.
Conclusion: Late presentation, high cost of haemodialysis, lack of diagnostic facilities and nonavailability of Noncommunicable Diseases Prevention Programmes are the main challenges faced in this centre. Preventive measures, RRT subsidies and universal health insurance are recommended to reduce the prevalence and morbidities/mortalities of CKD.
Keywords: Challenges; Management; Chronic Kidney Disease; Children; Nigeria
- Harambat J., et al. “Epidemiology of chronic kidney disease in children”. Pediatric Nephrology3 (2012): 363-373.
- Lysaght MJ. “Maintenance dialysis population dynamics: Current trends and long-term implications”. Journal of the American Society of Nephrology 13 (2002): S37-40.
- Schaefer B and Wühl E. “Educational paper: progression in chronic kidney disease and prevention strategies”. European Journal of Pediatrics11 (2012): 1579-1588.
- Schieppati A and Remuzzi G. “Chronic renal diseases as a public health problem: epidemiology, social, and economic implications”. Kidney International 68 (2005): S7-10.
- Anochie I and Eke F. “Chronic renal failure in children: a report from Port Harcourt, Nigeria (1985–2000)”. Pediatric Nephrology7 (2003): 692-695.
- Michael IO and Gabreil OE. “Chronic renal failure in children of Benin, Nigeria”. Saudi Journal of Kidney Diseases and Transplantation 1 (2004): 79.
- Ali ET., et al. “Chronic renal failure in Sudanese children: aetiology and outcomes”. Pediatric Nephrology2 (2009): 349-353.
- Asinobi AO., et al. “Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria”. BMC Nephrology1 (2014): 1-9.
- Warady BA and Chadha V. “Chronic kidney disease in children: the global perspective”. Pediatric Nephrology12 (2007): 1999-2009.
- Howard K., et al. “The cost‐effectiveness of increasing kidney transplantation and home‐based dialysis”. Nephrology1 (2009): 123-132.
- Odetunde OI., et al. “Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria”. Nigerian Journal of Clinical Practice 2 (2014): 196-200.
- Ladapo TA., et al. “Pediatric kidney diseases in an African country: prevalence, spectrum and outcome”. Saudi Journal of Kidney Diseases and Transplantation 5 (2014): 1110.
- Vachvanichsanong P., et al. “Childhood chronic kidney disease in a developing country”. Pediatric Nephrology7 (2008): 1143-1147.
- Huong NT., et al. “Chronic kidney disease in children: the National Paediatric Hospital experience in Hanoi, Vietnam”. Nephrology8 (2009): 722-727.
- Miller ME and Williams JA. “Chronic renal failure in Jamaican children--an update (2001-2006)”. West Indian Medical Journal3 (2009).
- Bhimma R., et al. “The spectrum of CKD (stage 2-5) in KwaZulu-Natal, South Africa”. Pediatric Nephrology9 (2008): 1841-1846.
- Ekpenyong EE., et al. “Challenges of peritoneal dialysis in the management of acute kidney injury in South-south Nigeria”. African Journal of Paediatric Nephrology 2 (2019): 45-50.
- Serdengeçti K., et al. “Registry of the Nephrology Dialysis and Transplantation in Turkey (Registry-2008)”. Istanbul: Published by the Turkish Society of Nephrology (2009): S2.
- McTaggart S., et al. “Paediatric report”. ANZDATA Registry report. (2009).
- Kidney Disease Outcome Quality Initiative. “K/DOQI clinical practice guidelines for chronic kidney disease: evaluation classification stratification”. American Journal of Kidney Diseases 2 (2002): S1-246.
- Schwartz GJ., et al. “A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine”. Pediatrics 2 (1976): 259-263.
- Oyedeji GA. “Socio-economic and cultural background of hospitalized children in Ilesa”. Nigerian Journal of Paediatrics 12 (1985): 111-117.
- Ardissino G., et al. “Epidemiology of chronic renal failure in children: data from the ItalKid project”. Pediatrics4 (2003): e382-387.
- Centers RI., et al. “Epidemiology of chronic kidney disease in Spanish paediatric population. REPIR II Project”. Nefrología (English Edition)5 (2010): 508-517.
- Mong Hiep TT., et al. “Clinical characteristics and outcomes of children with stage 3–5 chronic kidney disease”. Pediatric Nephrology5 (2010): 935-940.
- El Nahas AM and Bello AK. “Chronic kidney disease: the global challenge”. Lancet9456 (2005): 331-340.
- Dixon-Umo Ot., et al. “Outcome of Paediatic Renal Diseases in University of Uyo Teaching Hospital, Uyo, Nigeria”. World Journal of Biomedical Research (WJBMR) 1 (2015): 6-12.
- Luyckx VA., et al. “Acute renal failure associated with the use of traditional folk remedies in South Africa”. Renal Failure1 (2005): 35-43.