Feature: World Kidney Day- March 8

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Chronic kidney disease is on the rise in Barbados, as two of the main causes – hypertension and diabetes – continue to spiral out of control.

Over the years, the island’s lone public hospital, the Queen Elizabeth Hospital (QEH), has been inundated with patients requiring dialysis treatment in its Artificial Kidney Unit (AKU). The prognosis for the future is not a bright one if current figures continue along the same dismal path.

Statistics from the QEH reveal a disturbing picture. The AKU (formerly known as the Dialysis Unit), has moved from treating three patients in 1979, to 200 in 2011. If that’s not alarming enough, that figure is expected to double by the year 2020.

The demand is such that, at present, the AKU is unable to accommodate 24 patients who have been outsourced to a private provider. And, the Unit expects another 30 patient walk-ins over the next six months.

This raises a very interesting question – What exactly is the cost of treating chronic kidney disease?

The hospital presently spends a whopping $1.2 million, annually, to provide treatment for the aforementioned 24 dialysis patients who are treated at a private institution. That works out to about $300 per patient treatment.

In addition, it has lease and rental arrangements for 23 dialysis machines at a cost of $1.8 million a year, for five years. In total, direct costs to the QEH for providing dialysis services each year, stands at $6.5 million.

As Barbados, and the world, observes World Kidney Day (WKD) today with the slogan,?? Donate – Kidneys for Life – Receive, it is recognised that the prevalence of kidney diseases is increasing dramatically and the cost of treating chronic diseases, represents a major threat to health care resources worldwide.

In essence, it all boils down to lifestyle choices. In most cases, the prevention of this ailment is a matter of a healthy lifestyle: physical exercise, healthy food with limited calories and reduced salt, and not smoking. An important role of medical professionals in the prevention of CKD is, therefore, to serve as educators first.

Non-governmental organisations like the Barbados Kidney Association, which conducted blood pressure and cholesterol checks today in Jubilee Gardens, the City, (with representatives from the AKU), also do their part by creating awareness about kidney disease.

Vice President of the association, Theophilus Norville, has end-stage renal disease. He accesses the services of the AKU three times a week for treatment. While he believes some Barbadians are taking heed of the healthier lifestyle message, he does not believe the majority are listening.

??"The role [of the association], is to give people information about kidney disease and help members, for example, with medication if it is too expensive. We help them financially and go around to health fairs and do blood pressure and cholesterol checks. I don’t think the majority [of Barbadians] are acting upon the message but some do. We don’t want to wait until people have the disease.

"We are about prevention that is why we try to educate others. However, I am afraid a lot of people are not taking note – not only in terms of kidney disease but in other areas where they should be taking care of themselves," he said, adding: "The message I would give to Barbadians is to try and prevent kidney failure by looking after themselves; cut out a lot of the things they eat now that they should not be eating, and know their family history. It is also very important to exercise often and to eat in moderation."

Organisers of World Kidney Day suggest people observe these eight ???golden rules’: Keeping fit and active: keep regular control of your blood sugar level: monitor your blood pressure: eat healthy and keep your weight in check: maintain a healthy fluid intake: do not smoke: do not take over-the-counter pills on a regular basis: and check your kidney function if you have one or more of the high risk factors:

Common causes of this ailment include inflammatory diseases of the kidney, infections, obstruction in the urinary tract and inherited disorders like polycystic kidney disease. But in both developed and developing nations, diabetes and hypertension are becoming the most common causes of chronic kidney disease, especially in older people. These are also the most common causes of cardiovascular disease.

The first consequence of undetected chronic kidney disease is the risk of developing progressive loss of kidney function, leading to kidney failure and the need for dialysis treatment or a kidney transplant. The second is premature death from associated cardiovascular disease.

Chronic kidney disease affects people of diverse ages with the QEH reporting that it has been seeing younger patients over the years. Outside of dialysis, the hospital has been performing kidney transplants over the years, starting with the first in 1987. An additional nine transplantations were carried out between 1991 and 1996. The first for the new millennium was in 2010, when a 58 year-old father donated one of his kidneys to his 28 year-old son during a successful procedure.

The most recent was in early February this year, when, for the first time, laparoscopic kidney removal was done on the donor. This procedure results in a faster recovery time f-or the donor – a small incision is made to remove the kidney instead of a wide cut.

There are major benefits of transplantation over dialysis treatment. Patients who receive transplants are able to go back out to work and return to some state of normalcy. However, dialysis inhibits the patient as many of them have to receive treatment at least three times a week, for three to four-hour cycles each treatment.

Consultant Nephrologist at the QEH, Dr. Lisa Belle, said kidney transplant remained the best option for suitable patients with end-stage renal kidney disease. She noted, initially, it could be expensive in the first one to two years; costing approximately BDS$ 80, 000. However, she pointed out that the costs significantly declined after three years to less than half the costs of caring for a dialysis patient.

At the moment, donors are limited to family members since Barbados does not yet have transplant legislation.

melissa.rollock@barbados.gov.bb

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