Lower kidney function is independently associated with an increased risk of cardiovascular disease (CVD) and death in stable kidney transplant recipients, according to investigators.

At an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m², each 5 mL/min/1.73 m² increment in eGFR is associated with a 15% decreased risk of both CVD and death, researchers reported online in the American Journal of Transplantation. The investigators, led by Daniel E. Weiner, MD, of Tufts Medical Center in Boston, observed no association between eGFR and outcomes at eGFR levels above 45.

“The presence of an association between low eGFR and cardiovascular disease in transplant recipients suggests that comorbid conditions associated with low GFR itself rather than concurrent comorbidities that result in both low eGFR as well as systemic cardiovascular disease may be impacting cardiovascular risk,” the investigators wrote.

Reduced eGFR is independently associated with CVD events and mortality in the general population, the researchers noted. “Finding a similar relationship in kidney transplant recipients as in the general population suggests a possible direct effect of reduced GFR, since the transplanted kidney is likely to not have had a long exposure to traditional and nontraditional CVD risk factors,” the authors stated.

Dr. Weiner and his colleagues conducted a post-hoc analysis of data from 4,016 participants in the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial—which included patients who received a kidney transplant at least six months before enrollment. Over a median of 3.8 years, 527 CVD events occurred in the 3,676 subjects who had complete data.

They pointed out that their study has multiple strengths, including a large cohort, extensive ascertainment of CVD risk factors, systematic prospective ascertainment of CVD events, and the measurement of serum creatinine by a single laboratory. The study also has some weaknesses, including a lack of data on albuminuria and only a single assessment of serum creatinine for eGFR determination.

...

...

Today, I will be paying tribute to a friend who has touched me beyond measure. I have known Swani Gandu since the 1980s when both of us lived and worked in Kaduna. He worked at RIMS Merchant Bank and I, with Pfizer Products Plc. I can't remember exactly how we became very close but we gravitated towards each other. I visited him regularly in his office and, occasionally, at his home. We heartily discussed the politics of the day then, including the politics of the military government. In time, I also became close to his lovely wife, Comfort. Though we were exactly the same age, Swani got married long before most of us. He was much wiser.

Swani had always had a keen sense of humour. We laughed and laughed together as he would always find a good reason to laugh, and his laughter was infectious. He was also quite mischievous. He gave some of his friends different kinds of funny names. I will not mention the name he contrived for me.

As we grew up, our paths naturally drifted as we found new vocations. In time, he left RIMS and got absorbed with running Joy International School - a family business owned by his father - on the outskirts of Kaduna. For my part, I started spending more time in Abuja before finally moving in with my family.

The next time I heard from Swani was in 2003 when he called and wanted to join The Buhari Organisation (TBO). I was TBO's spokesman and deputy director-general then. I invited him to Abuja but, along the line, he got appointed assistant registrar of the Kaduna State College of Education, Gidan Waya, near Kafanchan. His wife was also employed as a lecturer in the college. Both of them are still in the employ of the institution.

And now to the crux of this column today: Swani didn't know he had been afflicted with diabetes that had even reached the advanced stages. One thing led to the other and he was forced to have a series of tests. After the tests, two of his toes had to be amputated at once. That was four years ago. And, since then, he has been walking around with excruciating pains with his feet permanently wrapped in bandage because sores and wounds in severely diabetic patients don't heal. My suspicion - even though I have not confirmed this anywhere - is that Swani must have been a little careless with his diet, as a diabetic patient. His current situation is worse than that of most diabetics I know - and I have very close friends that are diabetics and you'll hardly know, if they don't disclose their condition.

In a double whammy, about four years ago, a doctor in Kaduna carelessly and mistakenly injected him with antibiotics that are contraindicated in diabetics. Every doctor should know the relationship between Gentamicin, diabetes and the kidneys. The doctor administered Gentamicin to Swani and, before anyone knew what was happening, my friend had lost both his kidneys.

So that was how Swani, a decent and pleasant man, has been living in the last four years with severe diabetes and with no kidneys. Even though he is only 50, he now looks much older and more infirm than his father, who must be closer to 80 than he looks. But Swani is much happier than many of us. He is a very positive person and you will see that in him whenever he is not contending with the severe pains he is going through.

I didn't know how bad Swani's condition was until two days ago. A few months ago, he called to inform me that he was putting together an NGO, Kidney Care and Support Initiative, and he wanted me and a few others like Senator Esther Nenadi Usman and Dauda Iliya to be on the board of trustees. I accepted immediately, not because I knew the import of what he was about doing but simply because Swani was an old and trusted friend. He also requested to use the boardroom of LEADERSHIP for the NGO's meetings. I have not been able to attend any of the meetings because I was always out of the country whenever meetings were called. But he insisted that I drop all my programmes to attend the annual general meeting of the foundation and the board of trustees' meeting two days ago. I did, and that was when I saw Swani physically, the first time in 10 years.

Swani's positive attitude indicts all of us. Even though I had not set eyes on him for up to 10 years, we spoke often and nothing in his voice betrayed what he was going through. He was always his most cheerful self. Because he has lost his kidneys, he is not allowed to drink water because the water would get into the lungs and choke him, and, according to his wife, he has had close shaves several times. He is only allowed to lick ice. He also probably spends nearly half a million naira monthly to handle his ailments but that has not put him down either.

Attending the AGM on Saturday was an invaluable education for me. Two brilliant nephrologists, Dr Gimba Mark of the Jos University Teaching Hospital and Dr Lekan Olatise, the medical director of Zenith Medical and Kidney Centre, Abuja, presented excellent but heartrending papers on the challenges faced by kidney patients especially in an unjust country like Nigeria. That was when I knew that Swani probably spends nearly half a million naira every month, to manage his condition.

Swani said it was during his treatment that he met a little girl who died simply because she could not afford the money for dialysis. It costs an average of N25,000 for a session of dialysis and, since most patients must do it two times a week, it is not difficult to see why most of those who have this ailment in Nigeria die before their time.

And this is only because of the very irresponsible governments that this country has had. Most countries, including the very poor ones, are not like that. In spite of the poverty and the never-ending war in the Sudan, their leaders offer free dialysis services to their people. It is also free in countries like Egypt and South Africa. In Nigeria, only a couple of states have been that thoughtful and people-friendly. Katsina State offers free dialysis services to its indigenes. Bauchi State charges only N5,000 for everyone. That is very good but, even with that, most of those with the ailment will not be able to afford N10,000 weekly to remain alive. And in the whole of Nigeria with 774 local government areas, there are only about 50 places dialysis is done. So, every day, hundreds and thousands of afflicted Nigerians queue around these centres. Many will die before it is their turn, even with their money. Nigeria has a federal government and leaders who do not care two hoots about the people they rule over. That is the only thing that would explain why President Jonathan would jet out to Brazil when parts of his country were on fire. If the Jonathan government can corruptly share N2.6 trillion "subsidy money" among 140 contractors, many of whom did not supply a drop of fuel, then, you will understand how wicked those who govern Nigeria are. If Sudan, a much poorer country, can offer free dialysis to its people, then, you know Nigeria doesn't have leaders.

As government was doing nothing, Swani decided to set up the NGO. He didn't embark on this for himself. He obviously is able to afford it and he clearly doesn't want people to pity him. He was moved to set it up after witnessing the death of a little girl who was unable to afford the treatment. It is quite moving that, even though Swani is a victim himself, he has decided to help other victims who are less privileged.

When Swani's father, Barau Gandu, Tafidan Jaba, spoke during the meeting two days ago, he was full of praises for the son he was painfully proud of and ended by saying - in a reference to the NGO - that he was glad something good had come out of Swani's painful condition. Swani has used his ailment to bless others less privileged than he is. He then prayed for Swani. That was the only time I noticed my friend in tears.

During the programme, I sat with another friend, Thomas Etuh, who was the chairman of the occasion. In the course of our side talk, Thomas placed a few calls to suppliers to find out the cost of a new dialysis machine. That was when we found out that the best and most sophisticated ones cost less than N5 million a piece. Thomas immediately pledged to construct a dialysis centre for the Kidney Care and Support Initiative. Another person who touched me in the gathering was Dare Awonugba who works with the AIT to find support for sick and helpless people in need. After Dare spoke, Thomas pledged N500,000 to a little sick girl he emotionally talked about. Dare burst into tears.

Swani's example is that, whatever you are going through in life, you can always live a full life. As I said earlier, even though he is almost incapacitated by these ailments, he is obviously happier than many people I know. Immediately he saw me at the meeting, he called me by the funny name he alone had been calling me since the last 20-plus years we have known ourselves, bursting into a hearty laughter in the process. Swani is obviously still his very mischievous self.

Another person that has wowed me in all of this is Comfort, Swani's wife. Her equanimity, stability and strength of character is humbling. She is a wonderful wife and a wonderful mother. She is obviously a gift not only to Swani and their children, but to all of us. She is the type every wife should be.

My earnest prayer for Swani is that he should continue to live life to the fullest and for a very long time for that matter. And thank you, Swani, for teaching me life's lessons.

Jonathan's Cold-blooded Presidency

The world was shocked that President Goodluck Jonathan could jet out of the country when major parts of his country were literally on fire. But, apparently, he and his advisers saw nothing wrong with that. His minister of information, Labaran Maku, stretched common sense to the limits as usual, when he said the president can rule from anywhere - the same kind of nonsense we heard from Michael Aondoakaa, President Umaru Yar'Adua's attorney-general, when the late president was nowhere to be found. In certain circumstances, the most intelligent thing for advisers to do is keep quiet. It's obvious that it is only when the people's votes count that leaders take them seriously.

But Jonathan has always been like that. Since the conflagration started in Yobe and Borno states, the president has not been thoughtful enough to visit those states to assure the people. And, on a recent visit to South Korea, he said there was trouble only in a small part of Nigeria, in response to questions from people worried about the security situations of the country. You would think he is not also the president of that "small part". Compare this to presidents Bush and Obama who had visited US troops in Iraq and Afghanistan several times to show solidarity. We must ensure that the people's vote start counting in this country.

...

The Kidney Care and Support Initiative, a Non-Governmental Organisation (NGO) has raised the total sum of N5, 035.000 and pledges of two dialysis centers in support of people living with Kidney diseases.

The fund raising took place yesterday during the first annual general meeting/ the fund raising of the organisation in Abuja where the Chairman, Board of Trustees of the organisation, Mr. Swani B. Gandu appealed for a more compassionate approach to issues related to renal disease.

Associating themselves with the goals of the organisation, the Chairman LEADERSHIP Newspapers Group, Mr. Sam Nda- Isaiah and the Chairman of Tak Continental Group, Mr. Thomas Etuh both made personal donations of One million naira each to the organisation.

In his remarks, Mr. Gandu said that most Nigerians have lost their lives to kidney diseases not because there is no treatment but for the financial burden that has been placed on them in the course of getting the treatment.

"The idea to set up this organisation came to me four years ago when I lost my kidney and have to be placed on dialysis for survival. The treatment has taken me to various cities and it was during these trips that I saw the sufferings of my fellow Nigerians.

"Though dialysis has been improved upon in Nigeria, the prices still differ in various dialysis centers and there are people who cannot afford them. Some of these people need this dialysis three or four times in a week. Most of these people are dying, not because there is no treatment, but because of the financial burden which has been placed on them. "

Stating the reason for the high rate of Kidney diseases in Nigeria, Head, Department of Nephrology, Jos University Teaching Hospital, Dr. Emmanuel Agaba, represented by Dr. Gimba Mark revealed that hypertension, as well as drug abuse are the commonest causes of kidney diseases in Nigeria.

"The risk factors for kidney diseases are hypertensions, diabetes, and chronic glomeluron nephritis are usually the three commonest and diabetes is the commonest cause of kidney diseases worldwide, but hypertension and chronic are the most common in Nigeria. Also are lots of things that we do like use of drugs without prescriptions such as the pain killers, herbal medicines. "

...