Dialysis in Nigeria: 2 types and costs

Keen to know what dialysis means, cost of dialysis in Nigeria, types of dialysis, you are in the right place.

What is the meaning of dialysis?

Dialysis is the process by which waste products and excess water are filtered from the body. There are two types: Peritoneal dialysis and haemodialysis. Haemodialysis is more readily available in Nigeria than peritoneal dialysis.

Dialysis
Dialysis

The peritoneal cavity is a space between the two layers of thin sheaths that line the abdominal cavity and covers the abdominal organs. This is the space within which the dialysate fluid is held while some exchange takes place across the sheath or membrane.

Peritoneal dialysis

In peritoneal dialysis, a tube is passed through the abdomen into the peritoneal cavity and then a certain amount of fluid or drip (called the dialysate) is passed through the tube to the peritoneal cavity. This fluid contains various salts and when a certain calculated amount of it enters the peritoneal cavity, there is an exchange between the body fluids and dialysate such that waste/toxic substances that should be removed by the kidneys then enter into the fluid in the peritoneum.

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After some minutes, this fluid is then removed from peritoneum and discarded and the cycle continues for a few hours. The dialysate, before it enters the peritoneal cavity is clear and colourless but when it is removed from the peritoneal cavity, it is amber yellow in colour almost like urine.

This modality has some advantages over the haemodialysis and may be more convenient for the patients as it may be done in the comfort of their homes. It may be done overnight while the person is asleep and therefore saves time. This is however not readily available in most places in Nigeria except in a few private facilities.

Haemodialysis

In Haemodialysis, the patient’s blood is passed through some tubes that are connected to a machine which purifies the blood and returns it to the person’s body through a large cannula in the vein. A session of haemodialysis may last for two to three hours.

The access through which the blood is taken to the machine for purification could be either temporary or permanent. Temporary access includes the use of a catheter passed through the femoral vein at the upper aspect of the thigh, just below the abdomen. Second temporal access is the use of a catheter passed though the neck veins, this is called a central line.

It has an inflow and outflow tube. The third access which is a permanent one is the use of artero-venous fistula or AV graft. The AV fistula is created surgically- a connection between an artery and a vein and usually would be ready for use two to three months after the surgery.

In end stage renal disease, the kidneys are functioning at less than fifteen percent of their normal capacity, hence this individual would require renal replacement therapy. Dialysis ideally should be done three to four times per week. This may be difficult to achieve because dialysis is an expensive procedure and since most Nigerian patients make out of pocket payments, it may be unaffordable and unsustainable.

dialysis machine
dialysis machine

Cost of dialysis in nigeria

A session of haemodialysis in Nigeria costs between N35,000 and as high as N75000. It is usually more affordable at government owned health facilities than private facilities. Some state governments offer subsidized dialysis services to their indigenes.

Before dialysis, there are some blood tests that must be done:

Packed cell volume- to determine the amount of red blood cells in your body as the procedure would further reduce blood levels since there may be residual blood in the tubing after dialysis and some blood loss while establishing an access for the procedure. Various health care facilities have various PCV cut-off levels below which the patient would not be eligible for dialysis except blood is available for transfusion during or immediately after dialysis.

Hepatitis- Patients are tested for hepatitis infection i.e. hepatitis B surface antigen and anti-HCV before the procedure. Some facilities have separate dedicated machines for individuals who have any of these infections.

HIV test- This is also a compulsory test as some centres have dedicated machines for individuals with HIV infection.

Kidney function test- Serum electrolyte, urea and creatinine is necessary before the procedure in order to know those that require dialysis immediately based on biochemical parameters and also to have a basis of comparison after the procedure.

Certain medications are to be taken in end stage renal disease that help to perform some other kidney functions that are not covered by the dialysis procedure.

Erythropoietin injection: this is a hormone produced by the kidney that makes the bone marrow to produce red blood cells. It is to be taken either monthly or every two to three months depending on the type that is available.

Antihypertensive: Individuals with chronic kidney disease usually have elevated blood pressures because the kidneys have lost their ability to regulate blood pressures. The preferred antihypertensive include angiotensin converting enzyme inhibitors or angiotensin receptor blockers because they would reduce loss of proteins in the urine.  Other antihypertensive drugs may be used in addition to this group.

Vitamin D3: A synthetic form of vitamin D3 is important in regulating calcium and phosphate levels in the blood. It also helps to prevent bone disease in people who have chronic kidney disease.

Haematinics: These are drugs that improve red blood cell levels such as fesolate tablets, B vitamins and vitamin C.

Renal transplantation

This is a surgical procedure and a permanent renal replacement therapy in which a healthy kidney is transferred from one person to one with end stage renal disease. The kidney may be gotten from a person who is brain dead during organ harvest or from a healthy living adult. The kidney donor has to be tested to know if he/she has the same blood types as the recipient to determine if the person is a good match for the recipient or not.

After the transplantation of a new kidney, the recipient has to be on drugs to suppress their immune system in order for the graft (new kidney) not to be rejected by the body.

In conclusion, kidney diseases are better prevented because it is associated with high mortality as treatment is very expensive and unaffordable for majority of people who develop kidney diseases. Chronic kidney diseases may be prevented if acute kidney injury and kidney infections are promptly identified and managed proactively.

About the author

Doctor

Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.