STATE OF CHRONIC KIDNEY DISEASE IN GHANA AS WE CELEBRATE WORLD KIDNEY DAY 2021

World kidney day is a day set aside every year to create awareness on the impact of kidney disease globally. This has become necessary as a result of the increasing prevalence of chronic kidney disease globally, in Africa and in Ghana. The prevalence of chronic kidney disease is increasing worldwide and in Africa[1, 2]. The global prevalence is estimated to be 10-13%[1, 3] but the prevalence of chronic kidney disease in sub-Saharan Africa has been shown to be 13.9% in  a meta-analysis [4]. The prevalence of chronic kidney disease in Ghana has recently been shown in a study to be 13.3%[5].

Chronic glomerulonephritis together with non-communicable diseases such as hypertension and diabetes mellitus account for the increasing prevalence of chronic kidney disease in sub-Saharan Africa [6] and in Ghana[7]. Chronic glomerulonephritis has been suggested to be the most common cause of kidney disease in Ghana followed by diabetes and hypertension[8, 9]. It has also been shown in a single centre that up to about half of patients with hypertension have chronic kidney disease[10]. Though there is weak evidence in Ghana, it is believed that the rampant use of herbal medications may account for the significant increased incidence of chronic kidney disease among the younger population.

There is evidence however to show that some herbal medications can cause chronic kidney disease[11, 12] and acute kidney injury has been documented in Ghana in a case report[13]. There is also evidence to suggest that low birth weight is associated with early onset of chronic kidney disease[14] and since there is a correlation between low socioeconomic status and low birth weight, then low birth weight can also account for the increasing number of chronic kidney disease in Low  and low-middle income countries such as Ghana.

CHRONIC KIDNEY DISEASE is associated with increasing morbidity and mortality[9] and also known to impact negatively on quality of life[15]. Quality of life worsens with stage of kidney disease with the worst in patients reporting in CHRONIC KIDNEY DISEASE 5 or end stage kidney disease[16].

There is evidence in Ghana in a 10-year retrospective review of renal cases in a tertiary institution to show that the incidence of hospital admissions of kidney disease is on the rise and unfortunately over 75% of patients report in late stages of the disease [9] leading to the death of up to 50% of patients admitted with kidney disease[17]. Kidney disease in one of the top five causes of death on the medical ward at the Komfo Anokye Teaching hospital[17].

This high mortality is as a result of poor socioeconomic status of patients. Most patients requiring dialysis services cannot afford as management is not covered by the national health insurance scheme and patients have to pay out of pocket[18]. For those who can afford care, there is even unequal distribution of haemodialysis services in Ghana. Haemodialysis is available is in only five of the ten (now sixteen) regions in Ghana as shown in a study in 2016 [19].

So some patients will have to travel very long distances to access care for their end stage kidney disease when they can afford. This adds to the cost burden and affects quality of life. There are not enough dialysis machines in patients have to queue for their turn in most teaching hospitals with great burden on staff at the dialysis unit

In a 2017 review of the renal registry data, we found that there were 686 patients with end stage kidney disease on renal replacement therapy with the majority (96.4%) on dialysis. There were only 24 patients who have had transplantation. The mean age of patients with end stage renal disease on renal replacement therapy was 45.5%[20]. This study also highlights the renal replacement therapy in Ghana to be 23.56 per million population (pmp) which is very low as compared to high income countries with 738pmp[20]

As renal transplantation is not readily available in Ghana, most patients resort to travelling outside the country for transplantation. There has been renal transplantation of seventeen patients in Ghana since 2008 at the Korle bu Teaching Hospital by expatriate surgeons together with local expertise and recently last year about four patients through living donation [18] where done at the Korle Bu teaching Hospital. There are plans for another transplant this year at the Korle-Bu teaching hospital. Deceased donor transplantation is absent in Ghana. More kidney transplantation is encouraged as that has been shown to be cost effective, improve survival and improves quality of life as compared to dialysis.

There is also inadequate number of nephrologists in sub-Saharan Africa [21] to meet the growing needs of good renal care. Ghana has 0.26 nephrologist per million population[19] and more nephrologist need to be trained to help manage the growing burden of kidney disease.

With the high incidence, prevalence as well as high mortality associated with chronic kidney disease, there is less advocacy and knowledge about the disease. There is less funding into research and health promotion on the prevention of kidney disease. There has not been much research also into the effect of herbal medications been advertised out there on the kidneys as well as on other organs. I believe the fight against kidney disease will be won with health promotion as well as research into common causes of kidney disease and some funding to support patient with end stage kidney disease in Ghana.

As we celebrate world kidney day as a country in March, we cannot but support the theme for this year’s celebration which is ‘Kidney health for everyone everywhere living well with kidney disease’. I ask as a kidney health advocate that we become more interested in our kidney health, screen for kidney disease and its risk factors such as diabetes mellitus and hypertension. It’s also important to ensure that we also ensure those with chronic kidney disease are living well, long and with good quality of life.

Unfortunately, chronic kidney disease is usually without symptoms until late or complicated.  Early detection is key to prevent progression of kidney disease to end stage kidney disease. Because we have not yet achieved equitable access to care due to the enormous economic burden associated with kidney disease we edge policy makers to come up with sustainable ways to support people who develop kidney disease but let’s help ourselves by being responsible for out kidney health to reduce the burden of kidney disease in Ghana and across sub-Saharan Africa.

God bless us all!

Reference

1. Coresh, J., et al., Prevalence of chronic kidney disease in the United States. Jama, 2007. 298(17): p. 2038-2047.
2. Seck, S.M., I.M. Diallo, and S.I.L. Diagne, Epidemiological patterns of chronic kidney disease in black African elders: a retrospective study in West Africa. Saudi Journal of Kidney Diseases and Transplantation, 2013. 24(5): p. 1068.
3. Stenvinkel, P., Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. Journal of internal medicine, 2010. 268(5): p. 456-467.
4. Stanifer, J.W., et al., The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. The Lancet Global Health, 2014. 2(3): p. e174-e181.
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6. Pakasa, N.M. and E.K. Sumaili, The nephrotic syndrome in the Democratic Republic of Congo. New England Journal of Medicine, 2006. 354(10): p. 1085-1086.
7. Tannor, E.K., et al., Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross‐sectional study. The Journal of Clinical Hypertension, 2019.
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9. Tannor, E.K., et al., Quality of life among patients with moderate to advanced chronic kidney disease in Ghana – a single centre study. BMC Nephrol, 2019. 20(1): p. 122.
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11. Hsieh, C.-F., et al., Increased risk of chronic kidney disease among users of non-prescribed Chinese herbal medicine in Taiwan. Preventive medicine, 2012. 55(2): p. 155-159.
12. LAI, M.N., et al., Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid. Nephrology, 2009. 14(2): p. 227-234.
13. Tannor, E.K. and K.A. Hutton-Mensah, Naphthalene induced acute kidney injury in an African patient in Ghana: about a case report. Pan African Medical Journal, 2019. 32(201).
14. Xu, R. and L. Zuo, Low birthweight and chronic kidney disease. Nephrology, 2010. 15: p. 18-22.
15. Tannor, E.K., et al., Quality of life among patients with moderate to advanced chronic kidney disease in Ghana-a single centre study. BMC nephrology, 2019. 20(1): p. 122.
16. Tannor, E., et al., SUN-252 QUALITY OF LIFE AMONG THE STAGES OF CHRONIC KIDNEY DISEASE IN GHANA-A SINGLE CENTRE STUDY. Kidney International Reports, 2019. 4(7): p. S263-S264.
17. Tannor, E.K., K. Adusei, and B.R. Norman, A 10-Year retrospective review of renal cases seen in a Tertiary Hospital in West Africa. African Journal of Current Medical Research, 2018. 2(2).
18. Antwi, S., State of renal replacement therapy services in Ghana. Blood purification, 2015. 39(1-3): p. 137-140.
19. Tannor, E., et al., The geographical distribution of dialysis services in Ghana. Renal Replacement Therapy, 2018. 4(1): p. 3.
20. Boima, V., et al., SAT-017 End Stage Renal Disease in Ghana. Kidney International Reports, 2019. 4(7): p. S8.
21. Naicker, S., et al., Shortage of healthcare workers in sub-Saharan Africa: a nephrological perspective. Clinical nephrology, 2010. 74: p. S129-33.

Dr. Elliot Koranteng Tannor¹

Senior Specialist Physician/Nephrologist – Komfo Anokye Teaching Hospital, Kumasi, Ghana