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causes of kidney failure in patients receiving kidney replacement therapy in ghana.
Source publication
There are few data on the treatment of kidney disease in sub-Saharan Africa and no formal reports of kidney replacement therapy (KRT) in Ghana. We report data from the newly established Ghana Renal Registry on the prevalence, causes, and modality of treatment of kidney disease in Ghana. Using the web-based data capture system of the African Renal R...
Context in source publication
Context 1
... most common cause of kidney failure (Table 1) was hypertensive kidney disease, reported in 37.8%, followed by kidney failure of uncertain cause in 28.5%, diabetic nephropathy in 9.2%, and glomerulonephritis in 7.7%. HIV infection was present in 3.8% of the patients, 3.9% were hepatitis B surface antigen positive, and 0.8% were hepatitis C antibody positive. ...Similar publications
Home hemodialysis (HHD) is the cornerstone of renal replacement therapy in Germany. From 1969, it enabled survival with a diagnosis that up to then had been fatal; however, with the development of a good network of dialysis centers, the knowledge and experience of HHD was increasingly lost. Today, HHD is practically no longer included in the educat...
The prevalence of kidney failure continues to rise globally. Dialysis is a treatment option for individuals with kidney failure; after the decision to initiate dialysis has been made, it is critical to involve individuals in the decision on which dialysis modality to choose. This review, based on evidence arising from the literature, examines the r...
Citations
... Kidney health care in Africa is mostly characterized by limited availability of high-quality data, poor funding, low workforce density, and limited accessibility and affordability to KRT. 51 There have been efforts by the African Association of Nephrology (AFRAN) to augment and improve kidney registries on the continent, but this is inchoate and limited to a few countries. 52,53 The recent COVID-19 pandemic has further strained already weak health systems, thereby widening the already large gaps in health care infrastructure and financing. 54 The prevalence of CKD in Africa has previously been reported to be 15.8% 1 and 13.9% 55 in systematic reviews and meta-analyses, respectively. ...
... The South African registry has been the lead and has consistently published its annual reports since 2015 53 and encouraged others like Ghana to publish their first in 2021. 52 More effort should be put in by the AFRAN into registries to draw governments' attention to ensure timely and accurate Africa-wide data to inform policies and advocate for improved investment in kidney care in Africa. 75 It is essential to focus on prevention to decrease kidney disease burden due to challenges in providing optimum kidney care. ...
... A recent report of the Ghana renal registry corroborates that most patients on kidney replacement therapy in Ghana resulted from hypertension (38%) and diabetes and that 96.2% of them required haemodialysis (the main cost driver in the cost of treating hypertensive kidney disease in our simulation). 42 Our estimate show that using the recent evidence on the plausible prevalence of hypertension, the economic burden (in terms of treatment cost) is roughly GH¢ 438.124 million (ranging from GH¢ 377.394 million to GH¢ 503.192 million), which represents roughly 0.08% of the gross domestic product (GDP), but ranges from 0.07% to 0.09%) in 2022. In context, Ghana's health expenditure is estimated at 3.4% of GDP on health, hence comprehensively addressing the treatment needs of hypertension and related complications may require only a small proportional increase in health spending relative to the GDP. ...
... For example, there are facilities for haemodialysis in patients with kidney disease, but they are only available in 5 out of 16 political and administrative regions of the country. 42 Thus, the cost estimated in this simulation better represents a protocol-based cost of illness rather than the 'true cost' experienced by all patients across the country. Similarly, the majority of hypertension patients in Ghana are unaware of their status, and those aware are often not on appropriate orthodox treatment or are non-compliant with the recommended regimen. ...
Introduction
Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients’ and health system’s perspectives.
Method
We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness.
Results
The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723).
Conclusion
By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.
... 7 Chronic glomerulonephritis, diabetes mellitus, and hypertension are the most common causes of CKD in Ghana. 5 According to the first Ghana renal registry published in 2022, 8 the median age of patients undergoing KRT was 45.5 years. 8 Patients in Ghana develop kidney failure (KF) at a relatively younger age and mostly present late with advanced disease in over 75% of cases with up to 50% in-hospital mortality for patients admitted with KF in a single-center retrospective study due to inability to pay for KRT. 9 ...
... 5 According to the first Ghana renal registry published in 2022, 8 the median age of patients undergoing KRT was 45.5 years. 8 Patients in Ghana develop kidney failure (KF) at a relatively younger age and mostly present late with advanced disease in over 75% of cases with up to 50% in-hospital mortality for patients admitted with KF in a single-center retrospective study due to inability to pay for KRT. 9 ...
... 12 Most patients with KF are on hemodialysis (96.2%), functioning kidney transplant (3.5%), and 0.3% on continuous ambulatory peritoneal dialysis (PD) according to the first renal registry published in 2021. 8 Acute PD was initiated in Ghana in 2012 by Antwi et al. 10 and mostly used in pediatric population in the teaching hospitals and some district hospital but not for chronic dialysis in both adults and children in Ghana. ...
... Limited access to KRT results from unavailability and high cost in most parts of Africa, including Ghana [14]. Ghana does not have a sustainable kidney transplant program and haemodialysis (HD) is the most common modality for KF management [15,16]. According to the first Ghana renal registry in 2017, 96.2% were on HD, 0.3% on PD and 3.5% had kidney transplant [15]. ...
... Ghana does not have a sustainable kidney transplant program and haemodialysis (HD) is the most common modality for KF management [15,16]. According to the first Ghana renal registry in 2017, 96.2% were on HD, 0.3% on PD and 3.5% had kidney transplant [15]. There is also inequitable distribution of HD services in Ghana [17]. ...
... By December 2016 there were 15 dialysis centres with 103 HD machines in the country [17]. However, the rates of transplantation and peritoneal dialysis have however not increased significantly [15]. ...
Background
Kidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana.
Methods
A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana.
Results
There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most ( n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers ( n = 27, 67.5%) as the public sector ( n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4–10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana.
Conclusion
There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.
... In Benin, a study involving 131 chronic haemodialysis patients estimated ESRD of unknown etiology at 12.1% [63]. In Ghana, a prospective survey of 687 patients receiving dialysis estimated unknown etiology as the second common cause of ESRD at 28.5% [64]. ...
In the last two decades, there have been increasing recognition of excess cases of end-stage renal disease (ESRD) requiring renal replacement therapy without common underlying causes (diabetes, hypertension, glomerulonephritis, or any identifiable cause) in many parts of low-to-middle income countries. ESRD of unknown etiology mainly affects young working-age adults and is a global health problem with substantial morbidity, mortality and disability. In this review, we provide a comprehensive overview of the burden and outcomes of treated ESRD attributable to unknown etiology in African countries. Estimates indicate that up to 71% of adults and up to 53% children on dialysis suffer from ESRD due to unknown etiology. ESRD of unknown etiology affects mostly the economically productive young adults, males and those from rural areas. ESRD due to unknown etiology carries an almost twofold risk of mortality compared to traditional ESRD causes and account for up to 55% of the renal medical admissions burden. This review confirms that treated ESRD due to unknown etiology is a major public health issue in Africa. Future studies are urgent need for better characterizing the regional causative factors as well as for developing proactive and comprehensive approaches to prevent and treat this under-recognized disease.
... The largest intersection subset found in the 100 genes upregulated in GL and downregulated in PAN points at the therapeutic effects of GL on damage induced by PAN as a model for kidney disease. A GO term associated with these 100 genes was VEGF signalling, which we also found to be a major player in CKD in previous publications [4,97,98]. Also, in comparison to ANGII treatment, the largest subset was found in the 90 genes upregulated in GL and downregulated in ANGII. These 90 genes are associated with GO terms related to epithelial cell development, inflammatory processes such as interferon-alpha and leukaemia inhibitory factor responses and ERBB and BDNF signalling, while the 76 genes upregulated in both GL and in ANGII are associated with ADP synthesis and metabolism, several other metabolic processes and the positive regulation of acute inflammatory processes. ...
The global increase in the incidence of kidney failure constitutes a major public health problem. Kidney disease is classified into acute and chronic: acute kidney injury (AKI) is associated with an abrupt decline in kidney function and chronic kidney disease (CKD) with chronic renal failure for more than three months. Although both kidney syndromes are multifactorial, inflammation and oxidative stress play major roles in the diversity of processes leading to these kidney malfunctions. Here, we reviewed various publications on medicinal plants with antioxidant and anti-inflammatory properties with the potential to treat and manage kidney-associated diseases in rodent models. Additionally, we conducted a meta-analysis to identify gene signatures and associated biological processes perturbed in human and mouse cells treated with antioxidants such as epigallocatechin gallate (EGCG), the active ingredient in green tea, and the mushroom Ganoderma lucidum (GL) and in kidney disease rodent models. We identified EGCG- and GL-regulated gene signatures linked to metabolism; inflammation (NRG1, E2F1, NFKB1 and JUN); ion signalling; transport; renal processes (SLC12A1 and LOX) and VEGF, ERBB and BDNF signalling. Medicinal plant extracts are proving to be effective for the prevention, management and treatment of kidney-associated diseases; however, more detailed characterisations of their targets are needed to enable more trust in their application in the management of kidney-associated diseases.
... By December 2016 there were 15 dialysis centres with 103 HD machines in the country [17]. However, the rates of transplantation and peritoneal dialysis have however not increased signi cantly [15]. ...
... The HD patient prevalence in Ghana is 38.8pmp, a marginal increase from 23.6pmp reported in 2017 [15]. This remains lower than the average prevalence in Africa of 79pmp and a global average of 296 in a systematic review [12]. ...
... The 1,195 patients on HD in our survey represents only 7.8% of estimated patients with KF requiring HD in Ghana. Hence, some 92% of patients with KF have no access to KRT, consistent with the 90% reported for LMIC by GKHA[13] as PD and kidney transplants are in the minority[15].The cost of HD excludes other direct medical cost such as medications, intravenous iron, subcutaneous erythropoietin, arteriovenous stula as well as HD catheter costs. The average annual cost of HD for the required three sessions per week in Ghana, the cost of HD is borne directly by most patients out-of-pocket as the NHIS does not reimburse for HD. ...
Background
Kidney failure is common in Ghana. Haemodialysis(HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana.
Methods
A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana.
Results
There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4–10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana.
Conclusion
There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.
... Some patients in Ghana with ESRD receiving dialysis in Ghana, recounted their willingness to receive kidney transplants despite the high cost (Boima et al., 2020). Literature on the treatment of end-stage renal disease, symptoms, and experiences is inadequate in Ghana (Boima et al., 2021). This study focused on understanding the symptoms experienced by patients with ESRD receiving dialysis and other challenges faced in a regional hospital in Ghana. ...
Hemodialysis affects the socio-economic status of patients with end stage renal disease (ESRD) resulting in a large number of psychological disorders for both the patients and their families. The purpose of this study is to explore the experiences of patients undergoing dialysis at Greater Regional Hospital in Ghana. The researchers employed a qualitative phenomenological research design using and analyzed using Interpretive Phenomenological Analysis. A purposive sampling technique was employed by the researchers to select 16 participants who were engaged in face-to-face in-depth interviews conducted. The socio-demographic characteristics revealed that majority were males (n = 11; 69%)and more than half of the participants (n = 14; 87.5%), were over 40 years. Again, most of the participants indicated spending between 150USD to 180USD weekly on dialysis treatment alone. The study revealed 3 themes and 13 subthemes emerged from the analysis of this data. The main themes were the Physical experiences of patients prior to starting dialysis, personal experiences during dialysis and socioeconomic burden on the participants. Participants faced challenges prior to and whilst on dialysis however the symptoms were better whilst on dialysis. It is therefore recommended that participants with ESRD are supported to go through dialysis treatment to enhance their quality of life.
... Both Ang II/MasR and Ang II/Ang R are potent anti-inflammatory, anti-2 fibrotic peptides that increase levels of nitric oxide [29] . It appears underlying hypertension is linked to [27,30] increased severity of COVID-19 disease and that hypertension potentially increases [31] inflammation and endothelial dysfunction , that is associated with blunted production of nitric [28,32] oxide Furthermore, studies in Africa including Zambia, have shown that hypertension was the a prevalent cause of renal dysfunction in patients with [10,33,34]. kidney failure To our knowledge, this is the first study in Zambia demonstrating a rate of kidney dysfunction in hospitalized patients with COVID-19 diseases. ...
Background: A significant link has been reported between COVID-19 pneumonia, disease severity and development of kidney dysfunction. This study assessed the prevalence and correlated factors for kidney impairment in hospitalized patients with COVID-19 infection Methods: This nested retrospective study examined medical files of patients with confirmed COVID-19 pneumonia. The outcome variable was kidney dysfunction ( defined as functional renal indexes beyond the normal range) and associated factors. Multivariate logistic regression was employed to establish factors associated with renal dysfunction. Results: 179 patients were included in this nested study and the mean age was 58.3 years (SD 16.5) and 49.0% were female. The prevalence of renal dysfunction was 51.9% and 39.3% these patients renal had eGFR<60 mL/min/1.73m2 The proportion of kidney impairment was higher in males than females (59.3% vs.44.3 %), patients with underlying hypertension than normotensive (60.5% vs. 39.5 %) and those with chronic kidney disease (CKD) than those without (90% vs. 10%). After adjusting for age, male gender, critical COVID-19 disease, and raised white cell count, hypertension was an independent predictor of kidney impairment with a AOR 1.54 (95% CI [1.06-2.23],p=0.022). Presence of HIV or diabetes mellitus showed a non statistical significance with renal dysfunction. Conclusion: The study demonstrated a high prevalence of kidney dysfunction in hospitalized patients with COVID-19 pneumonia and presence of hypertension predicted nearly 2-fold development renal impairment.
... South Africa currently has the most successful and complete renal registry data and has published annual reports for the past 8 years. Ghana published the first annual report of its registry data in 2021 [40]. It is hoped that these efforts will be maintained and reproduced in other countries to establish and strengthen renal registries data in Africa [41]. ...
Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. conclusion: Africa needs greater investment in kidney health.
