How tobacco, alcohol consumption affect the kidney —Nephrologist

Professor Fatiu Arogundade, consultant physician and nephrologist at the Obafemi Awolowo University Teaching Hospital in an interaction with Nigerian Tribune sheds light on the issue. Excerpts:

What are the causes of renal failure?

The causes of chronic kidney disease in Nigeria, as in many other African countries, are hypertension and chronic glomerulonephritis. Diabetic nephropathy ranks a distant third and a rising prevalence has been observed in the country.

What is the age bracket of patients admitted for chronic kidney diseases?

It has also been found that chronic kidney disease and end-stage renal disease patients present at a relatively young age usually between 20 and 50 years. So, we mostly see cases of patients in their 20s, 30s, 40s and 50s. Sometimes, we get older patients too. This is probably because of the preponderance of infection-related chronic glomerulonephritis and the predisposition of blacks to hypertensive renal damage. The effect of genetic susceptibility is increasingly being recognised also.

How does the consumption of alcohol and tobacco affect the kidney?

Well, alcohol consumption does not have a direct negative effect on the kidney but it does affect the heart and the liver adversely and consequently, there is an indirect effect on the function of the kidney. Tobacco on the other hand is like a facilitator and enhancer. In chemistry, people talk about catalysts, something that makes a reaction go faster; we can see tobacco as that. Where there is existing kidney damage, tobacco consumption becomes ultimately lethal because it speeds up the deterioration of the kidney and pushes the renal disease to the end-stage where dialysis will be required or eventually, a transplant. So, invariably, consumption of these substances will affect one or two vital organs of the body directly and some others indirectly and there are consequences.

Can you give us an estimated statistics for patients admitted at the OAUTHC for chronic 

kidney disease and end-stage renal disease yearly?

Yearly, we can have between 500 and 700 patients. It is about that figure. 

Individuals are seen sourcing for funds required for treatment in most cases. Why is treatment so expensive?

The management of end-stage renal disease in Nigeria as in many parts of the world is costly, especially as in our setting, individual patients are directly financially responsible for their care, government subsidy is virtually nonexistent, and renal care is still not covered by the national health insurance scheme. Thus, the outcome is a very high mortality rate with about 80 per cent of end-stage renal disease patients dying within a few weeks of diagnosis.

In our center, hemodialysis remains the most commonly prescribed renal replacement modality in 70 per cent of cases, though only 5 per cent of the patients are able to sustain the treatment for longer than 12 weeks, mainly because of these financial constraints. Continuous ambulatory peritoneal dialysis has been offered in only 1.2 per cent and kidney transplant in just 1 per cent of our patients.

How effective is kidney transplant and what are the related challenges?

Though kidney transplant is recognised globally as the gold standard treatment modality for end-stage renal disease patients because of its overall cost effectiveness and guarantee of an almost normal quality of life, it has its constraints, which include the huge financial outlay at the outset, shortage of donor organs, challenges of immunosuppression and very recently, organ trafficking.

Source: The Tribune