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Coronavirus adds to troubles of kidney patients


coronaimage

Drug shortage looms

Tuesday March 17 2020

Patients might soon start feeling the heat of heparin shortage even as the world marked kidney day last week.

The World Kidney Day came at a time when there is a coronavirus outbreak, first reported in China, and kidney patients around the world and in Kenya are facing the implications of the disease.

Heparin, a drug for kidney dialysis patients, is also used in surgery to stop clots. It is derived from pig intestines and China supplies 60 to 80 per cent of the active pharmaceutical ingredient.

Patients who go to dialysis units have already been warned that they might soon not be able to access services should the situation remain the same. “Some hospitals have told us that the drugs they have can only last a month and so we are scared of what will happen should they run out,” said John Gikonyo, who has a pre-existing kidney condition.

World Kidney Day is meant to raise awareness of the increasing burden of kidney diseases worldwide and to strive for health for everyone, everywhere. The focus this year is to raise awareness on the importance of preventive interventions to avert the onset and progression of kidney disease.

There are two preventive interventions, primary and secondary. Specifically, primary prevention of kidney disease requires the modification of risk factors, including diabetes mellitus and hypertension, unhealthy diets, structural abnormalities of the kidney and urinary tracts, and or nephrotoxicity levels.

Preventive primary interventions include promotion of healthy lifestyles including physical activity and healthy diets, screening of patients at higher Chronic Kidney Disease (CKD) risk with the aid of urine and blood tests and keeping screening data in a registry.

NHIF CLAIMS

One of the things that could help in primary prevention is cutting the use of salt says Dr Norm Campbell, former president of the World Hypertension League who wrote in the Journal of Clinical Hypertension, that it was time for a more hard-hitting approach to dietary salt reduction. “Unhealthy diets are a leading cause of death globally and excess salt consumption is the biggest culprit, estimated to cause over three million deaths globally in 2017,” said Dr Campbell.

“The World Health Organization established a target for countries to reduce sodium intake by 30 per cent by 2025, and governments and the food industry have been working together to reduce salt in processed foods,” added Dr Campbell.

In people with pre-existing kidney disease, secondary prevention, including blood pressure optimisation and glycemic control, is the main goal of education and clinical interventions which can be achieved by low salt and protein, as well as plant-based diets and pharmacotherapy.

John Gikonyo, who has a pre-existing kidney condition, says it is a little expensive to manage the condition because you cannot just eat what you want. “You have to be conscience of what you eat or drink and that can be a little expensive because it is sort of a special diet,” he says.

In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is of high priority.

The Kenya Renal Association estimates that the number of patients on chronic haemodialysis — a treatment that filters and purifies the blood using a machine — in both private and public hospitals has increased by eight times from 300 in 2006 to 2,400 in 2018.

According to the National Hospital Insurance Fund (NHIF), dialysis is the single largest claim made to the fund. Top conditions paid by the insurer include maternity, renal failure, influenza, malaria and pneumonia.

A scrutiny of the benefits package utilisation report shows that in the last half of 2018, NHIF paid Sh64.7 million towards kidney transplants, up from Sh21.7 million the previous year. In 2016, NHIF paid hospitals Sh839.9 million between July and December, up from Sh139.8 million in a similar period a year earlier — a five-fold increase.

The World Kidney Day is coming at a time when the world is facing an outbreak of the Coronavirus and kidney patients around the world and in Kenya are facing the implications of the disease.

Heparin, a drug on kidney dialysis patients is also used in surgery to stop clots is derived from pig intestines and China supplies 60 to 80 percent of the active pharmaceutical ingredient.

Patients who go to dialysis units have already been warned that they could soon not be able to access services should the situation remain the same. “Some hospitals have let us know that the drugs they have can only last a month and so we are scared of what will happen should they run out,” he said.