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 Of those who did begin dialysis, most quit, usually within two
weeks, because they could not afford to continue, and 88 percent
died, the research found.
Quitting dialysis almost always proved fatal.
“Among those who do manage to scrape together enough money to begin
dialysis, the majority cannot afford to continue to pay for dialysis
and die within weeks of starting, very likely after having depleted
their family’s resources,” senior author Dr. Valerie A. Luyckx of
the University of Zurich, Switzerland said in an email.
Luyckx, a kidney specialist who also studies biomedical ethics,
worked on the study with colleagues in Cameroon, Ghana, Senegal and
South Africa. Together they reviewed 68 previous studies covering
nearly 25,000 adults and more than 800 children.
Fifty-nine percent of the adults and 49 percent of the children
stopped life-saving dialysis treatments for financial reasons,
despite needing to continue, they found.
The high attrition rates raise ethical questions about whether
healthcare workers should present dialysis as an option to patients
who cannot afford it, Luyckx and her colleagues write in Lancet
Global Health.
In most sub-Saharan countries, patients must pay out of pocket for
dialysis, she said. She described the costs as “prohibitive” and
“catastrophic” because they “likely plunge families further into
poverty.”
Of those who needed dialysis but failed to receive it, 96 percent of
adults and 95 percent of children died.
Only about 10 percent of adults and 35 percent of children with
end-stage kidney disease remained on dialysis for three months, the
study found. For people with this condition, the only alternative to
dialysis that would allow for survival is a kidney transplant.
In an accompanying editorial, Dr. Ikechi G. Okpechi called the
findings “alarming and outrageous” and said they should motivate
policymakers to address care for those with end-stage kidney disease
in the region.
But “I have doubts that these data will influence those in
government in sub-Saharan Africa,” wrote Okpechi, a kidney
specialist at Groote Schuur Hospital and University of Cape Town in
South Africa.
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The government of Nigeria recently agreed to pay for the first two
weeks of dialysis, Okpechi said. However, he added, “Such small,
albeit positive, steps are a drop in the ocean.”
"(The study’s findings) make a strong case that there is an ethical
imperative for governments to acknowledge the dire consequences of
the lack of policies which lead to inequitable access to dialysis,”
Luyckx said.
As many as 23 percent of adults in sub-Saharan Africa have chronic
kidney disease, and up to 3 million people die every year because
they lack access to dialysis, her team writes.
If treatment for end-stage kidney disease is unaffordable, “adequate
palliative care options should be in place such that patients don’t
disappear or abscond from hospital to die, likely often humiliated
because they cannot pay,” Luyckx said.
“Like for HIV/AIDS,” Okpechi writes in the editorial, “countries in
sub-Saharan Africa should stop burying their heads in the sand and
realize that the burden of (end-stage kidney disease) will worsen
and every small step taken in the right direction now will help to
save lives in the future.”
SOURCE: http://bit.ly/2lB50Pb and http://bit.ly/2mTQwdK Lancet
Global Health, online February 17, 2017.
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