Chronic Hemodialysis in a Nigerian Teaching Hospital

The Jos University Teaching Hospital (JUTH) has dialyzed >320 patients with ESRD since 1993. Objective:  To identify differences, and their causes, in the practice of dialysis between Nigerian state-owned dialysis units and U.S.A. Methods:  We analyzed the characteristics of chronic dialysis at JUTH. Results:  At JUTH, chronic dialysis is started at development of frank uremia (K/DOQI standard: creatinine clearance >10 mL/min, no overt uremia). Frequency of hemodialysis was 3 times weekly in 2 patients, twice weekly in 1 and once weekly or longer in 7 patients. Breakdowns in the dialysis machinery, which is outdated, forced additional decreases in the frequency of dialysis. Duration of a dialysis session was 4 h by prescription, but much longer in several sessions because of dialysis machine breakdown during the session (US standard: 4 h). 2 patients were dialyzed through arterio-venous fistulas and 8 patients were dialyzed though temporary femoral vein dialysis catheters removed after each dialysis session. A vascular surgeon was unavailable. The urea reduction ratio was 45.38.6% (U.S.A target: 65%). The cost of the first dialysis session at JUTH is $160. With reuse of dialysis supplies, including dialyzers, dialysis tubing, femoral catheters, and guide wires, the cost of each subsequent dialysis session is $33. The minimal cost of dialysis with 3 dialysis sessions weekly and a new dialyzer every week is $501 per month. The cost of dialysis is borne exclusively by the patient. For comparison, average monthly income is $74 for unskilled laborers, $222 for dialysis technicians, $296 for dialysis nurses, and $889 for academic nephrologists. The low dose of dialysis has adverse effects on patient quality of life (frequent admissions with uremia). Despite notable exceptions (2 patients on dialysis for 12 and 9 years, respectively), survival of dialysis patients at JUTH appears to be poor. Conclusions:  Underdialysis is frequent in Nigeria and is the consequence of socioeconomic conditions and technologic deficits. Removal of the economic burden of dialysis from the patients with ESRD is the first logical step toward correction of underdialysis.