American Journal of Medical Sciences and Medicine
ISSN (Print): 2327-6681 ISSN (Online): 2327-6657 Website: http://www.sciepub.com/journal/ajmsm Editor-in-chief: Apply for this position
Open Access
Journal Browser
Go
American Journal of Medical Sciences and Medicine. 2020, 8(2), 46-53
DOI: 10.12691/ajmsm-8-2-2
Open AccessOpinion Paper

Community Primary Healthcare Centre-Renal Centre Linkage Program for the Reduction in Burden of CKD/ESRD in Low and Middle income Countries

Friday Wokoma1, 2, Pedro Emem-Chioma1, 2, and Manda David-West2

1Department of Medicine, University of Port Harcourt, PMB 5323, Port Harcourt, Nigeria

2Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173 Port Harcourt, Nigeria

Pub. Date: April 26, 2020

Cite this paper:
Friday Wokoma, Pedro Emem-Chioma and Manda David-West. Community Primary Healthcare Centre-Renal Centre Linkage Program for the Reduction in Burden of CKD/ESRD in Low and Middle income Countries. American Journal of Medical Sciences and Medicine. 2020; 8(2):46-53. doi: 10.12691/ajmsm-8-2-2

Abstract

In the Low and middle income countries (LMIC) CKD and ESRD constitute a major cause of morbidity and mortality affecting predominantly the young and middle age groups with far reaching socioeconomic implications. The exact data are not available, the prevalence of CKD and the incidence of ESRD in most LMIC jurisdictions are about 10-17% and over 1500 per million populations (pmp), respectively, though RRT prevalence averages 255pmp. The burden of human suffering is enormous and the financial burden of care is far beyond the reach of the individual sufferer and most LMIC countries are incapable of providing Medicare type of care for their subjects with ESRD. Thus the diagnosis of ESRD in most LMIC countries is synonymous with a death sentence. In the present state of practice in the LMIC countries, the unmet need of nephrology practice is the challenge of reducing the burden of CKD and ESRD in the communities through preventive nephrology approach. Even in developed countries with state of the art facilities for care, there is the prevailing need for reducing the burden of CKD in recent times. CKD and ESRD preventive programs such as the KEEP and similar programs are in place. KEEP-like programs are unfortunately not appropriate for LMICs on account of technology and IT attributes. Paradoxically, in most LMIC jurisdictions with the highest burden of ESRD and the least in access to care, there are no forms of structured sustainable CKD/ESRD containment programs. Some previous efforts in this direction could not be sustained because they were not integrative in nature and were funded by donor agencies. We propose the Community (PHC)-Renal Centre linkage program which would enable a permanent link between the rural based PHC centres with urban based Renal centres. This pivotal link will be achieved through the services of purpose trained Community Preventive Nephrology practitioner (CPN-P). The CPN-P identifies and manages CKD risk factors and early CKD cases at the PHC level and transfers advanced stages to the affiliate Renal centres in teaching and specialist hospitals. The CPN-P bridges the long missing nephrology care gap in the LMIC jurisdictions. With good record keeping Renal data from the communities would be used to develop Renal Registry in the area.

Keywords:
LIMC CKD community renal centre linkage program

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Bello AK, Levin A, Tonelli M, Okpechi IG, Feehalley J, Harris D, et al. Risk and burden of CKD. In: Global Kidney Health Atlas(GKHA): A report of the international society of nephrology on the current status of organization and structure for kidney care across the globe. International Society of Nephrology(ISN), Brussels, Belgium 2017; pp. 29-30.
 
[2]  Fresenius Medical care. ESRD patients in 2009: A global perspective. Monograph on ESRD 2010; PEFC/04-31-0987: 1-10.
 
[3]  Valerie A Lucyckx Katherine R Tuttle, Gulliemo Gracia-Gracia, Mohammed Bebghanem Gharbi, Hiddo JLHerspink, David W Johnson,et al. Reducing major risk factors for chronic kidney disease. Kidney Int suppl 2017; 7: 71-87.
 
[4]  United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2017.
 
[5]  Naicker S. Burden of end stage renal disease in Sub-Saharan Africa. Clinical Nephrology 2010; (74) Suppl, 1: S13-S16.
 
[6]  Arogundade FA, Sanusi AA, Hassan MO, Akinsola A. The pattern, clinical characteristics and outcome of ESRD in Ile-Ife, Nigeria: Is there a change in trend? Afr Health Sci 2011; 11: 594-601.
 
[7]  Wokoma FS, Okafor UH. Haemodialysis experience with chronic kidney failure patients at the University of Port Harcourt teaching hospital; Trop J Nephrol 2010; 5(2): 97-104.
 
[8]  CKD in the United States 2017 USRDS Annual Data Report Executive Summary. 2017 USRDS Annual Data Report Volume 1.
 
[9]  US Renal data system. (USRDS) Annual data report: Atlas of chronic kidney disease in the united states of America 2011 Annual data report vol. 2. 2011.
 
[10]  Naicker S. End-stage renal disease in Sub-Saharan Africa. Kidney Int, 2013; Suppl. 3:161-3.
 
[11]  Vivekanand, Jha. Current status of end-stage renal disease care in India and Pakistan. Kidney International Supplements (2013) 3, 157-160.
 
[12]  Wokoma FS, Emem-Chioma PC, Oko-jaja RI. Burden of risk factors of CKD in LIMC. Systematic Analysis of Community studies of Risk Factors and the Prevalence of CKD in Nigeria(2006-2014) Tropical Journal of Nephrology 2016; 2(1): 7-11.
 
[13]  Lugon JR, Strogroff De Matos. Disparity in End stage kidney disease care in South America. Clinical Nephrology 2010; 74, Suppl 1: S66-S71.
 
[14]  Malada ND, Thusi GP, Assounga AG, Naicker S.Characteristics of South African patients presenting with kidney disease in rural Kwa Zulu-Natal: A cross sectional study. BMC Nephrol 2014; 15: 16.
 
[15]  Stanifer JW, Jing B, Tolan S, Helmke N, Mukerjee R, Naicker S, et al. The epidemiology of chronic kidney disease in sub‑Saharan Africa: A systematic review and meta-analysis. Lancet Glob Health 2014; 2: e174-81.
 
[16]  Gerntholtz TE, Goetsch SJW, Katz I. HIV-related nephropathy: A South African perspective. Kidney International 2006; 69: 885-1891.
 
[17]  Emem CP, Arogundade F, Sanusi A, Adelusola K, Wokoma F, Akinsola A. Renal disease in HIV-seropositive patients in Nigeria: An assessment of prevalence, clinical features and risk factors. Nephrol Dial Transplant 2008; 23:741-6.
 
[18]  Fabian, J. Naicker S. HIV and kidney disease in sub-Saharan Africa. Nat. Rev. Nephrol. 2009; 5: 591-598.
 
[19]  Kadiri S, Arije A, Salako L. Traditional herbal preparations and acute renal failure in south west, Nigeria. Trop Doctor 1999; 29: 244-246.
 
[20]  Jayasumana C, Gajanayake R, Siribaddana S, Jayasumana S, et al. Importance of Arsenic and pesticides in epidemic chronic kidney disease in Sri Lanka. BMC Nephrology 2014; 15:124.
 
[21]  Luyckx VA, Naicker S. Acute kidney injury associated with the use of traditional medicines .Nature Rev Nephrol 2008; 4(12): 664-672.
 
[22]  Wokoma FS, Emem-Chioma PC. Income distribution and source of funding for maintenance haemodialysis of patients in the University of Port Harcourt teaching hospital. Trop J Nephrol 2010; 5(1): 17-22.
 
[23]  Unuigbe EI. Funding renal care in Nigeria: a critical appraisal. Trop J Nephrol 2006; 1(1): 33-38.
 
[24]  Alebiosu CO, Ayodele OO, Abbas A, Olutoyin AI. Chronic renal failure at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Afr Health Sci 2006;6:132-8.
 
[25]  Madala ND, Thusi GP, Assounga AG, Naicker S. Characteristics of South African patients presenting with kidney disease in rural Kwazulu-Natal: A cross sectional study. BMC Nephrol 2014;15: 2-9.
 
[26]  Amira CO, Bello BT, Braimoh RW. Chronic kidney disease: A ten-year study of aetiology and epidemiological trends in Lagos, Nigeria. Br J Ren Med 2015; 19: 19-23.
 
[27]  Rajapurker M, Dabhi, M. Burden of disease- prevalence and incidence of renal disease in India. Clinical Nephrology, 2010; 74: S9-S12.
 
[28]  US Renal Data System. USRDS 1999. Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Bethesda, MD, 19 US Renal Data System.
 
[29]  Naicker S, J B Eastwood, Plange Rhule J, TUtt RC. Shortage of health care workers in Sub- Saharan Africa: a nephrological perspectives. Clinical Nephrology 2010; vol.11 suppl 1: S129-S133.
 
[30]  .Neil Pearce, Shah Ebrahim, Martin McKee, Peter Lamptey, Mauricio L Barreto, Don Matheson, et al.The road to 25×25: how can the five-target strategy reach its goal? February 5, 2014. www.thelancet.com/lancetgh Vol 2 March 2014
 
[31]  Ohmit SE, Flack JM, Peters RM, Brown WL , Grimm R. Longitudinal study of National Kidney Foundation Kidney Early Evaluation Program (KEEP).
 
[32]  Aminu K. Bello, Emeka Nwankwo, and A. Meguid el Nahas. Prevention of chronic kidney disease: A global challenge Kidney International, 2005; Supplement 98 : S11-S17.
 
[33]  Meda R. Prevention of CKD in Guatamala.( Foundation for children with kidney disease. (FUNDANIER).Clin Nephrol 2010; 14 (suppl.1): S126-S128.
 
[34]  Ajay K Singh, Youssef MK, Bharati V Mittal. Kuyilan Karai, Sai Ram Reddy, Vidya N Acharya et-al. Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and early evaluation of kidney disease) study. BMC Nephrology 2013; 14:114.
 
[35]  Andrew Narva. Population Health for CKD and Diabetes:Lessons from the Indian Health Service. Am J Kidney Dis. 2017; 71(3): 407-411. Published Online, December 5, 2017.