NEPHROLOGY - DIALYSIS THERAPY SERVICES

Vision:

To be the leader in preserving the health and wellbeing of patients with kidney diseases in Africa

Mission

To excel in the practice of renal medicine through applying and generating clinical evidence relevant to the needs of the people of Uganda

Values

Clinical excellence, cultural relevance, cost consciousness, global competitiveness, continuous quality improvement

1.      Introduction and Background

Chronic kidney disease (CKD) is an important global public health problem, estimated to affect 10% (700 million) of the world’s population by 2017. CKD risk has been mainly exacerbated by infectious diseases such as HIV, Malaria and diarrheal diseases and their treatment, as well as non-infectious diseases especially hypertension and diabetes, and finally the use of potentially nephrotoxic traditional and non-traditional medicines.

A recent survey conducted by the Uganda Kidney Foundation, points to an increase in the kidney disease burden. Uganda continues to grapple with non-communicable diseases, with over 25 percent (1 in 4 Ugandans) at risk of kidney diseases, while the condition continues to bite in, many of the affected persons present to the health facilities very late with advanced disease and hence limited options for relief or cure.

Poorly functioning kidneys prevent extra water, waste, and other impurities from being removed from the body. These therefore build up resulting in disease manifestations including: body swelling, generalized itching, nausea and vomiting, bleeding tendencies and eventually premature death. Kidneys also help control blood pressure and regulate the levels of various chemical elements in the blood thus loss of function will also manifest with related complications such as low blood levels, and an increased risk of bones breaking if not promptly treated.

When the kidneys can’t perform these functions due to disease or injury, dialysis can help keep the body running as normally as possible. Without dialysis, salts and other waste products will accumulate in the blood, poison the body, and damage other organs.

Dialysis is the process of removing excess water and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Dialysis performs the function of the kidneys when they have failed. Therefore, in that condition, a machine is employed to purify the blood so it can balance fluids or does the work the kidney should have done. It is in other simple terms what one could call kidney-life support.

2.      Current Situation

There are more than 350 sessions of dialysis performed at Kiruddu National Referral Hospital on a weekly basis. The hospital has been offering life-saving renal replacement therapy to the patients since it started offering services to the public in 2016. The number of dialysis machines started with was 19. With the increasing demand for the hemodialysis services, the hospital managed to increase the dialysis machines numbers to 30 in the year 2020. It is estimated the dialysis machines will need to be doubled to 60 within five years.

The arrangement in which the hospital acquired the dialysis machines is through placement. Meaning to say that the hospital does not need to pay for the dialysis machines and services. All the equipment related responsibilities are well taken care of by the professional service providers. So that the hospital can concentrate on the medical services provided to the patients (including the purchase of the consumables).

3.      Goal and Objective
To make the dialysis center in Kiruddu National Referral Hospital a state-of-art dialysis center with at least 60 dialysis machines, providing Hemodialysis, Hemodiafiltration (HDF), and Hemoperfusion to the patients.

4.      Achievements made in the last three years

a.       Raised the dialysis machine numbers from 19 to 30

b.      Reduced infection rate on the ward

c.       Computerized patient record management system

d.      Introduced online HDF treatment

e.       Increased the dialysis budget by lobbying stakeholders to appreciate the need for increased funding for dialysis service

f.        Increased the kidney disease clinic days from…. To….

g.      Introduced quarterly dialysis RO water quality tests

h.      Availed gowns, appropriate foot wear, bed sheets blankets, head wear to staff

i.        Conducting regular laboratory (microbiologic and biochemical) quality checks on water for dialysis

j.        Developed checklists and SOPs to ensure safety of patients undergoing dialysis.