Friday, December 3, 2021

MOH intensifies search for sustainable kidney disease treatment

Princess Marina Hospital (PMH) Deputy Superintendent and Clinical Director Dr. Ishmael Makone (FRACP) says Botswana should intensify more cost-effective and sustainable kidney disease prevention, better screening and kidney failure risk factors elimination, in the wake of more than 300 PMH chronic kidney disease (CKD) patients, with a third and the remainder, on Peritoneal Dialysis (PD) and Haemodialysis (HD), respectively. 

In the absence of the preventive intermediations, the cost burden becomes compounded taking into account the Hospital’s pool of patients awaiting extraneously exorbitant organ transplants. 

Addressing medical doctors and clinicians attending an Adcock Ingram, SA, wholly-funded  two-day renal care workshop in Gaborone last week, Dr, Makone who is a Fellow of the Royal Australasian  College of Physicians (FRACP) said: “We should take into consideration that treatment of  end-stage kidney disease by different modes of dialysis and transplant is very expensive and unsustainable in our setting, hence the need for prevention, better screening and removal of the factors that can cause kidney failure.

Dr. Makone said: “We have seen to our dismay, the recent global surge in non-communicable diseases (NCDs) equally impacting developed and developing world including Botswana, such as obesity, hypertension and diabetes, the leading CKD causes. We encourage the patients to adopt positive lifestyle practices, eat healthy foods and be more physically active, as a last best hope for minimizing the incidents of kidney disease apart from promoting general well-being. 

“However, the PMH renal service, a critical milestone achievement, offers PD and HD as medical therapeutic treatment for severe kidney failure or end-stage disease patients.”

The good news is that the majority of kidney problems are preventable. Good blood pressure control in Hypertensive patients and sugar control in Diabetics, adequate nutrition, over-the-counter medication controls, in particular, some herbal drugs including traditional medicines can protect kidney patients from developing kidney failure.

There are patients, who will go into renal failure, require some form of dialysis, despite mounting effective prevention strategies.

The PMH renal service has become a centre of excellence joining other medical specialization facilities such as the Block Diabetic, the Wits University supported Arthroplasty, Mauritius backed Cardiac operations, Hypertensive pregnancy Disorders Centres, to name some. The Nephrology Centre of Excellence operating twice weekly, serves a classic example of the Hospital’s modernisationcompetency.  

Dr. Makone commended Adcock Ingram for inviting renal Intensive Care Unit (ICU) Specialist Physician Dr. Bret Cullis as the leading instructor throughout the workshop to advance the incumbent healthcare professionals’ education, support PD development and facilitate delivery of the much-needed high quality services, consistent with the Ministry of Health’s objective of reaching out to rural communities around Botswana.

Adcock Ingram is a South African world-clas pharmaceutical company listed on the Johannesburg Stock Exchange, manufacturing and marketing a wide range of healthcare products such PD equipment, technology and consultancy. 

According to Wikipedia, PD treatment is for patients with severe CKD, using the patient’s peritoneum in the abdomen as a membrane across which fluids and dissolved substances like electrolytes, urea, glucose, albumin and other small molecules are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps, called automatic PD or via regular exchanges throughout the day known as continuous ambulatory PD. As an HD alternative PD is far less commonly used in many countries, such as the US. PD has comparable risks but is significantly less costly in most parts of the world, with the primary advantage being the ability to undertake treatment without visiting a medical facility. The primary complication of PD is infection due to the presence of a permanent tube in the abdomen.

While HD is a method used to achieve the extracorporeal removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of renal failure. HD is one of three renal replacement therapies apart from renal transplant and PD. As an alternative method for extracorporeal separation of blood components such as plasma or cells is apheresis.

In outpatient or inpatient settings therapy, it is conducted in a purpose built facility, either within a hospital, clinic or less frequently at home. Clinical treatment is initiated and managed by specialized staff made up of nurses and technicians; or self-initiated at home and managed or done jointly with the assistance of a trained helper, usually a family member. 

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