Challenges and pitfalls in the management of end-stage renal disease in Nigeria: Medicolegal implications

Abstract

The burden of kidney disease is on the rise, especially in sub-Saharan Africa, including Nigeria, with a significant proportion at end-stage renal disease (ESRD), and requiring a form of renal replacement therapy (RRT). The management of ESRD in Nigeria faces several critical pitfalls that hinder effective care and contribute to poor outcomes. Some of these challenges include: high cost of treatment and out-of-pocket payment burden, limited access to RRT, late presentation and diagnosis, inadequate manpower and infrastructure, absence of a national renal registry, cultural and social barriers and paucity of legal framework. The several medicolegal implications associated with kidney care in Nigeria primarily revolve around the following: medical malpractice in kidney care; autonomy, informed consent and parental rights; access to treatment and equity issues; ethical and legal challenges in transplantation and patients’ rights. The paucity and gaps in legislation, coupled with poor implementation of existing regulations in Nigeria, have repeatedly resulted in negative consequences for patients who require RRT. The review concluded that medical practice will sometimes be associated with legal troubles for practitioners; hence, the need for nephrologists and other health practitioners to be acquainted with medical laws and regulations, and for hospitals to have a medicolegal unit cannot be overemphasised.