UG students conduct research at GPHC Nephrology Department

AT the Georgetown Public Hospital Corporation (GPHC), in the Nephrology Department which deals with kidney failure patients, the maintenance cost for one hemodialysis patient is almost two times higher than the cost for a patient who undergoes renal transplant.
On average, hemodialysis costs the government $2.3 million per year, per patient, while the renal transplant cost is drastically less costing some $746,000 per year, per patient.
This was the conclusion coming out of a recent study conducted by a group of fifth year medical students of the University of Guyana, School of Medicine.

“Our research revealed that the total cost for hemodialysis over a five year period was fond to be $11,548,377, while the total cost for a transplant patient over the same period was found to be $3,730,920 a ratio of 3.2 times more,” the research paper said.
The costs take into consideration daily medication, requisite medical supplies and laboratory fees.

The study entitled “A comparative analysis to determine the maintenance cost of hemodialysis versus renal transplantation at the GPHC” was a part of the students’ Community Field Assessment, and also included a comparative study of the morbidity and mortality of patients undergoing the different remedies.

“We thought it was a very good research topic because it’s not an area where a lot of study has been done and there has been [an advent] in terms of patients who have kidney failure. So with all of that in consideration we went ahead with that research,” explained group member, Christine Singh.

Head of the Nephrology Department, Dr Kishore Persaud commended the study noting the lack of data in the area, and the need for even more studies.

“The thing about the research is that so far no one has actually established what is the incidence or the morbidity and mortality of these kidney failure patients; what is the economic cost to the hospital and these patients, so I think it’s a stepping stone for the future results and it has also given us a guidance as to what is the economic burden for the government in terms of what are the patients costing to sustain in the hospital,” explained Persaud, a renal surgeon.

Hemodialysis and renal transplantation are two options available to persons suffering from stage five kidney failure, that is they have loss some 80–90 per cent of kidney function.
With hemodialysis the blood is taken out of the body, filtered through a dialysis machine and then returned to the body, with the machine functioning as a replacement for the kidney; whereby kidney transplantation, simply replaces the failed kidney with a functioning one from a donor.

Hemodialysis is very time consuming and requires the patient to undergo therapy two to three times a week. The GPHC Dialysis Centre has been in operation for six years, and according to Kishore, the Centre currently caters to some 100–150 dialysis patients; a yearly cost of $230-$346 million.

However while the results would lean towards renal transplant being the better option, the transplantation process faces greater challenges. The biggest being a constant supply of donors.

“Out of that [hemodialysis] group 75 per cent will qualify for a transplant. What would make them not get a transplant is that they do not have a donor. The main fact is to get a kidney to put into them. The small group that has a family to donate to them that is the group we try to do,” Kishore explained.

The researchers believe that age has a lot to do with it.

“In Guyana, donor shortage may be one of the most influential reasons for the age discrepancy between the hemodialysis and renal transplant groups,’ the study said.
Younger patients are more likely the ones to move on to renal transplantation.

Between the two treatments, 46.4 per cent of dialysis patients were between the ages of 51 and 70 years, while 66.7 per cent of renal transplant patients were between the ages of 17 and 30 years. Moreover, older patients tend to have more co-morbid conditions at the time of renal transplantation, which increases the chance of postoperative mortality, when compared to younger patients.

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