Of the more than 5,000 Kenyans who undergo dialysis due to kidney failure, less than 30 have chosen an unusual path.
They no longer travel to a clinic twice a week for machines to filter their blood. They do it at home.
They use a fluid that they put in the belly to clean the blood. The process is called peritoneal dialysis and is one of the only two ways dialysis is done. The common method using machine filters in hospitals is called haemodialysis.
PD works like this: The patient gets a catheter to fill the belly with a cleaning fluid called dialysate. The liquid stays in the belly for about six hours as it cleanses the blood. The tissue that covers most of the organs in the belly (the peritoneum) acts as a filter for this process.
During this time, the patient is free to do their daily activities. Afterwards, he or she will drain the used liquid out of the belly and refill it with fresh dialysate.
According to the Kenya Renal Association, PD is cheaper and survival rates are higher. But why is it so underutilised?
KRA president Dr Jonathan Wala, a nephrologist, blames the moribund National Health Insurance Fund.
“A few regrets exist in this long journey in the pursuit of more equitable access to kidney health. Firstly, peritoneal dialysis, a home-based cheaper option for dialysis was not considered, and therefore was not covered by NHIF,” Dr Wala said.
With haemodialysis, a patient travels to a clinic twice a week and spends hours there while a machine filters their blood. The NHIF reimburses the clinic about Sh18,000 a week. Patients then endure restrictive diet, fatigue and the nausea that accompanies the treatment.
PD patients have more freedom, and they save on transportation costs that hemodialysis patients incur. They are also more productive in life.
However, dialysate liquid is expensive and this option, without insurance coverage, is unaffordable to most patients.
Dr Grace Ngaruiya, a PD champion and University of Nairobi nursing lecturer, has conducted studies that show PD is cheaper for the economy and better for patients in the long run.
In 2022, Dr Ahmed Sokwala, a nephrologist at Nairobi’s Aga Khan University Hospital, led two of his colleagues to find out from nephrologists why peritoneal dialysis has failed to pick up in Kenya while it is growing in other parts of the world.
There were 30 nephrologists in clinical practice in Kenya when the study was conducted, according to the Kenya Renal Association registry.
The nephrologists reported only about 20 Kenyans were on PD at that time.
They cited the lack of insurance reimbursement as the biggest barrier to uptake of this form of dialysis.
“Most nephrologists felt that PD as a modality was indeed underutilised with 54 per cent reporting that they felt at least 20 per cent of incident end-stage renal disease patients should be initiated on PD,” the authors said.
The results of this study were published in the Canadian Journal of Kidney Health and Disease.
The paper titled: "Perceived Barriers to Peritoneal Dialysis Among Kenyan Nephrologists: A Cross-Sectional Descriptive Study."
They also cited a lack of hospital support for peritoneal dialysis with 81 per cent reporting that they felt that hospitals did not offer support for PD.
They noted a lack of adequate nursing expertise and a lack of support for PD in patients’ homes.
There were fears about the common infection, peritonitis, among patients, product failure, problems with catheter placement and concerns about long-term viability of continuous peritoneal dialysis.
Dr Wala says the new Social Health Insurance Fund would let down patients if it does not cover PD.
“Universal Health Coverage, which is a key cog in the government’s agenda, requires proper health financing as a key pillar. We warn those in the Treasury, in the Ministry of Health and in Social Health Authority that the lives of these dialysis patients are in their hands," he said.
"These patients have faithfully paid the monthly premium demanded from them, why should they be denied the health service due to them?”