Transplantation best treatment for kidney failure — Researcher

The Head of Medicine and Therapeutics at the University of Ghana Medical School has stated that the best treatment of kidney challenges should be kidney transplantation, saying it has more benefits compared to dialysis.

Delivering his inaugural lecture at the University of Ghana last Thursday, Professor Vincent Boima, cited a study conducted by him and his colleagues, which showed that about 45 per cent of patients who were on dialysis had depression such as persistent sadness, loss of interest, poor sleep and low energy, which translated to four to five of every 10 people receiving dialysis.

“Nearly 20 per cent of these people actually have poor quality of life, perhaps as a result of a long-standing illness and depression.

Again, we look at some of our data across Ghana and Nigeria and found a similar pattern. So, we know that mental illness can affect adherence to medication and therefore potent poor outcomes for these patients,” he said.

He said non-adherence to medication in their study was actually associated with depression, which meant that when people had depression, they were more likely to be non-adherent and probably had a poor outcome.

Prof. Boima said the study also looked at how people were coping with kidney issues, and mentioned the strategies to include collective debriefing and cognitive debriefing.

Lecture

The inaugural lecture, which was on the theme: “From genes to mind: Holistic pathways to precision kidney care for Africa,” talked about how genes predisposed people to the development of kidney disease and how chronic illnesses, including chronic kidney disease, affected people’s minds.

The study was based on a baseline version conducted thousands of years ago that established a relationship between gene types and environmental exposure.

Inaugural lectures are a significant tradition and part of the university’s calender, and every academic who rises to the rank of a full professor is expected to deliver one. 

It offers the university the opportunity to recognise and showcase the academic achievements of its faculty and also enables professors to share their research insights with colleagues within and outside the university.

Risks

The Head of Medicine and Therapeutics at the University of Ghana Medical School threw light on how certain genes of individuals can become a risk or safeguard in connection with kidney failure.

Prof. Boima said the study he conducted with other Ghanaian academics revealed that exposures to some toxins within the environment could react with people’s genes to damage their kidneys.

For instance, it said exposure to heavy metals such as mercury, lead and arsenic as a result of galamsey activities could interact with people’s genes to increase their risk of kidney disease.

Again, intake of other toxins such as unverified herbal medications and over-the-counter pain killers can also interact with one’s genes to increase their risk of developing kidney disease.

The study, therefore, called for measures to be put in place to screen people at high risk of developing the gene — which manifests in two variants — that were associated with kidney disease.

That way, he said, treatment could be tailored to improve their outcomes.

Original research

Prof. Boima said the original research work that brought genetic predisposition to kidney disease was done in the United States (US), where it was found that  African-Americans in the US were the ones who had the high prevalence of those genes.

He said that study further found out that most of the people in the US who were having high frequency of those particular genes were from West Africa.

The study was, therefore, brought to Africa to be conducted again and it was done largely in Ghana and Nigeria with the principal investigator being Prof. Adu, with co-investigator Professor Mate Kole and other faculty members of the UG.

Describing it as a landmark finding, Prof. Boima said it was the first such study to be conducted in sub-saharan Africa with a larger sample size.

He said the study revealed that 43 per cent of the study population in Ghana had one risk variant of the gene that caused kidney and close to 30 per cent of them had two risk variants.

He explained that they discovered from the study that when one had two risk variants, the risk of developing chronic kidney disease increased by 25 per cent and the risk of developing chronic inflammation in the kidney increased by 84 per cent.

He said one striking thing they found from the study was that there was an ethnic disparity in the distribution of those genes in sub-saharan Africa.

“So taking Ghana, for instance, 37.2 per cent of Akans had the two risk variants compared to 19 per cent of the Gas and 17 per cent of people from the Volta Region.

And we discovered a similar ethnic disparity also in Nigeria where the Igbos have 42 per cent higher prevalence of the two risk variants compared to the Yorubas and the Fulani who have about 12.1 per cent.”

Professor Boima, a professor of medicine and nephrology, said even though the reasons for those presentations were not known, they posed a huge public health problem which required that measures were put in place to screen people at high risk of developing this gene associated with kidney disease and tailor-made treatment that would improve their outcome.

“That’s the precision kidney care we are talking about. When you find the underlying cause, target it with therapy and treat the patient like that.

That means that you probably are able to improve outcomes of care,” he said.

The study recommended, among others, the broadening of the national health insurance coverage to ensure more people were covered and protected as well as help the cost of medications and make them more accessible.

Profile

In a brief profile read by the Vice-Chancellor of the University of Ghana, Prof. Nana Aba Appiah Amfo, she described Professor Boima’s career as one defined by a mission to improve systems for the prevention, early detection and sustain treatment of kidney disease, while generating locally relevant evidence to improve outcomes for African patients.

She said the lecture sought, among others, to reframe kidney care through a holistic precision, nephrology model that integrated genetics, psychological well-being and community-based prevention and continuity of care.

Present at the inaugural lecture were members of the university’s community, academics, including Professor Mathew Kyei and Professor Alfred Yawson, the family of Professor Boima and old students of his alma mater, Bishop Herman College.