Thursday, January 18, 2018

Kidney disease on the rise in T&T

One in every four adults may be affected


FLASHBACK: Nephrologist Dr Emile Mohammed during a cheque presentation ceremony made by Pepsi Trinidad, distributors of Ocean Spray, to the John Hayes Memorial Kidney Foundation at Lonsdale, Saatchi & Saatchi Advertising Ltd, Herbert Street, St Clair in April. —Photo: ISHMAEL SALANDY

Mark Fraser

There is currently a chronic kidney disease rise in the country and it is a much bigger problem than many realise, consultant nephrologist  Dr Emile Mohammed has said.

Speaking at the Third Annual U Health and Wellness Expo at the Hyatt Regency (Trinidad), Port of Spain,  Mohammed — who looked at the ABC (Advent, Boom and Current situation) of kidney disease in Trinidad and Tobago using Pan American Health Organisation (PAHO) statistics and international medical case studies — said: “It is a big problem”, in this country. 

One in every four adults may unknowingly be suffering from the disease.

“Sadly, in Trinidad kidney disease is not known about much but it is more common than we think. Some of you are thinking, well, those poor kidney patients who are on dialysis. Well, you don’t just develop end stage kidney disease. Kidney disease happens in stages. You have five stages; stage one is kidney damage, stage two is if your kidneys are mildly impaired, stage three is moderately impaired, stage four is severely damaged and stage five is when you are put on dialysis. 

Kidney disease is not just about dialysis, everybody thinks kidney disease is about dialysis or transplantation. As kidney function deteriorates the chances of dying rise exponentially and most of those deaths are heart attacks and strokes,” Mohammed pointed out.

He said there were lots of emerging cardiovascular risk factors associated with kidney disease, but what was of concern was that with protein in the urine and the worse a person’s kidney function was, their risks of dying of a cardiovascular event became higher.  

“If you have protein in your urine you are more likely to have a heart  attack and stroke than if you previously had a heart attack and stroke. 

There is a fear of kidney failure but risks are actually heart attack and a stroke, especially in the early stages,” he said.

The link between Cardiovascular 

Disease and Chronic Kidney Disease 

Citing United States studies, chronic kidney disease propagates cardiovascular disease and vice versa, he said. 

“They go hand in hand. And a conservative estimate is that 25 per cent of the adult population locally is diabetic and 25 per cent hypertensive, 50 per cent overweight. We know that 40 per cent of the diabetic population will have chronic kidney disease at some stage and about 25 per cent of the Afro-Trinidadian population are hypertensive and will have chronic kidney disease at some stage.” 

However, he said, apart from diabetes and hypertension there were other factors causing chronic kidney disease in this country and one of them lupus.

“Lupus is very high in this country and they affect the kidneys at a higher rate and at a more severe rate. So we have a lot of problems and I suspect every one in four adults in Trinidad and Tobago will have some form of chronic kidney disease,” he said.

The Dialysis Issue 

  Mohammed, who works at the Port of Spain General Hospital, said he was aware that the country had a problem with dialysis, since he puts between 80 and 90 new patients on dialysis every year, some as emergency cases but most of them at stage five or end stage kidney disease.

This has significant socio-economic implications attached to it because dialysis is very expensive.

“It is about US$60,000 per patient, in the developed world. We don’t know what the cost is per patient in Trinidad but we do know what the government pays towards outsourcing, which is less than half of that of developed countries,” Mohammed said.

Citizens of this country, he said, have continued to get fatter over the past decade because of a dramatic lifestyle change within a short period between two generations.

Mohammed used data from PAHO to compare Trinidad and Tobago to some other regional countries with regard to non-communicable diseases and he said the data showed that this country was excelling in the numbers when compared to countries like the US, Canada, Cuba and even Barbados.

“We are way out there. When you look at stroke, when you look at chronic heart disease Trinidad and Tobago just seems to stand out. This is the boom of chronic kidney disease in Trinidad,” he said.

Mohammed said the number of people on dialysis over time rose quite rapidly and then started to plateau. 

This took place when Government started providing funding for dialysis and was seen up to 2010.

He said a very conservative estimate of patients per year requiring dialysis was 288 patients per million so in real terms, this country had about 350 to 400 patients every year who needed dialysis. 

“The prevalence of the amount of patients on dialysis at any one point in time at the moment is about 750 patients.”

Mohammed said Barbados and Curacao, which have similar numbers per million of kidney patients are both treating more patients on dialysis than this country.

“Barbados has over 800 patients per million on dialysis, Curacao has almost 1,400 per million and we have 500 patients per million.

“So in other words the number of patients we have on dialysis is way lower than it should be which is very worrying. In my experience the lower prevalence of dialysis patients may be due to a combination of patients not having dialysis because there is still something called waiting lists. We have very high mortality rates and we therefore have to be more selective,” he said.

Mohammed added that he observed that dialysis patients in Trinidad tended to be of a younger age group than dialysis patients in other countries around the world.

Looking at how dialysis affects patients, he said they had increased cardiovascular disease mortality. 

“Observational studies done on thousands of dialysis patients show the annual cardiovascular mortality rate with two groups: the general population and the dialysis population.

If you are  a 25-year-old man on dialysis the chances of you dying of a heart attack and a stroke is the same as if you were an 85-year-old man in the general population. 

“So being a dialysis patient predisposes you to having a heart attack or a stroke in a much more dramatic way than if you were in the general population,” he added.

Steps to curb the boom 

Mohammed said he believes the way in which this country approaches its health is simply not working and although there are initiatives by Government more needs to be done.

“It is unacceptable and I think there are two approaches we need to think about. We need to think about it with a public health point of view and as a personal initiative. 

“From a public health point of view we are now starting to talk about Ministry of Health initiatives. There are many effective interventions that have been proven in other countries over time in laws and regulations to bring down non communicable disease.

These are advocacy, information, communication community-based intervention, school intervention in Scandinavian countries, education at all levels. There are many things that work,” he noted.

Locally, he said there needs to be a little more methodology in how patients are screened and preventing the overall risks must be looked at as well as rehabilitation. 

“We need public health ministry-led programmes. There are some but we need to step it up.

We as individuals must take responsibility for our health. It is well and good to say what the Government has to do but how many of us know our numbers?” he asked.