On World Kidney Day 2024, Guyana’s Presidential Commission on the Prevention and Control of NCDs focus attention on the truth that globally, after March, each year, we return to business as usual and pay little attention to a major public health challenge. Chronic Kidney Diseases (CKD) affect just over 10% of the global population, leading to death and disability and represent one of the major global disease burdens. But there is also increasing incidences of acute kidney injuries (AKI). Given that diagnosis, treatment and care represent a major cost for public health sector in Guyana and around the world, the time has come for every single day to be World Kidney Day. The time has also come for a revolution in the way the world address the problem of CKD and AKI.
The Commission urges more equity in access to Kidney Replacement Therapy (KRT). A significant percentage of persons living with CKD will require KRT. Most Guyanese and most people around the world know KRT as dialysis and kidney transplants. Theoretically, dialysis is supposed to be a temporary fix, with the hope that kidney transplant will end the patient’s agony. But the truth is that for people in most countries today, kidney transplant is not accessible. For developing countries where kidney transplants are available, access is limited. But even dialysis is limited in most developing countries and there are still countries that have no access. There is need for a revolution in which KRT becomes commonplace and no country is without access.
Fortunately, in Guyana, we have made tremendous improvement in access to KRT. Our kidney transplant program has grown significantly and in 2024 we are establishing a Center of Excellence for Kidney Transplant at the GPHC. Working with the University of Calgary and other partners, 2024 will be pivotal in the establishment of the Nephrology and the Transplant Center of Excellence. The Commission commend the MOH for ensuring Guyana creates equity in access to KRT.
The Commission is encouraged that the new digital pathology lab will build capacity for HLA testing in Guyana. This new capacity will enable the introduction of Deceased (Cadaver) Donation Kidney Transplant. This means that kidneys from deceased persons can be used for the first time in CARICOM for transplants. It was only in July 2021 that the Dr. Kishore Persaud-led team performed kidney transplant on the first patient from CARICOM to benefit from the Guyana Transplant Center, an initiative towards Tourism Medicine. It was also in December 2023 that the team performed the first pediatric kidney transplant, transplanting a father’s donated kidney into a seven
year-old girl with this being the smallest child to have benefitted in the entire Caribbean, a testament to our quality of care. Furthermore, this team also recently successfully performed the first Laparoscopic Donor Nephrectomy to procure the kidney for Transplant, showcasing our Innovative and World Standard approach to health care.
Our dialysis access has expanded to Regions 2, 3, 4, 6 and 10. Persons from other regions can access with government support dialysis centers in these regions. The Commission urges introduction of dialysis centers in all regions of Guyana. To support dialysis, each person on dialysis is provided with $600,000 per year to support access in the private sector. In addition, laboratory testing and medicine costs are in excess of $1M annually per patient. These are commendable initiatives. Guyana’s goal must be that every citizen in need of dialysis must gain access without creating family poverty.
The Commission urges an end to inequity in early detection of kidney diseases. Simple testing for HBA1c, Albumin Creatinine ratio and eGFR are not easily available to people. The global kidney health revolution must include universal access to such simple testing. Guyana must work towards universal access to such simple testing, bringing these within the ambit of primary health care. We believe that this is the re-definition of primary health care that VP Bharat Jagdeo speaks about.
We urge the introduction of new medicines that have appeared in developed countries in all developing countries.
Most developing countries utilize the same old treatment regimes we have been using for decades. In Guyana, new guidelines are being developed that are trying to make room for new classes of medication. In developed countries, new classes of medication that improve management of hypertension, diabetes and CKDs are making quantum-leap in improving care and outcomes. These medicines, including SGLT-1 and SGLT-2 medicines, such as Jardiance and Ozempic, are too costly for developing countries. But Guyana must examine the earliest introduction of these medicines.
As we observe World Kidney Day 2024, we must endeavor to bring more education and awareness of kidney diseases. We must make simple diagnostics and KRT more accessible to people and new medicines for better management must be more accessible. For kidney diseases, there are expanding inequities globally. The WHO must lead a revolution that ends this inequity. Guyana must provide a leading voice to end such inequity when it comes to kidney health.
