Overuse of painkillers driving cases of chronic kidney disease

In 2019, Ken Anjejo, a resident of Kisumu, began experiencing symptoms he initially dismissed as ordinary fatigue. He experienced persistent headaches, night sweats, unexplained weight loss, and constant fatigue.

The 43-year-old resorted to over-the-counter medication, taking strong painkillers to ease the headaches, but the relief was only temporary. After months of relying on painkillers, Anjejo finally sought medical tests and was diagnosed with high blood pressure.

Even after the diagnosis, he continued using strong painkillers to manage severe headaches and fatigue.

Two years later, he was diagnosed with chronic kidney disease, a condition in which the kidneys become damaged and can no longer efficiently filter waste and excess fluids from the blood.

The cause of his disease, he says, remains unclear. “I have never been obese, and I have no history of hypertension or diabetes. So I do not know what caused my kidney disease,” Anjejo explains.

He struggled to accept the diagnosis and spent at least two years trying to restore his kidney function, but there was no improvement.

In October 2019, a nephrologist (kidney specialist) advised him to either start dialysis or undergo a kidney transplant, as he was at high risk of kidney failure.

Anjejo opted for dialysis, as he could not afford a transplant. In July 2020, he began dialysis, a life-sustaining treatment that removes waste and excess fluid from the blood when the kidneys can no longer perform this function. He has been on dialysis ever since.

“I was in denial after being diagnosed with chronic kidney disease. I initially refused dialysis, but I eventually had to accept the treatment, as the damage was irreversible,” Anjejo narrates his ordeal.

Today, Anjejo undergoes two dialysis sessions every week (every Wednesday and Saturday). The Social Health Authority (SHA) covers Sh10,650 per session — an increase from Sh9,500 under the defunct National Health Insurance Fund (NHIF). However, beyond dialysis, he spends between Sh20,000 and Sh30,000 every month to manage complications associated with the disease.

For instance, he sometimes requires blood-boosting injections, which cost between Sh2,000 and Sh10,000 per dose. He also undergoes regular laboratory tests, such as calcium level monitoring.

Even with treatment, Anjejo suspects that his previous work in gold mining and prolonged use of strong painkillers may have triggered his chronic kidney disease.

“At no single day did I ever leave home without painkillers in my bag—the stronger ones to relieve the pain. The pain was too much to bear, but here I am, managing the condition,” he says.

Anjejo’s experience with chronic kidney disease reflects that of hundreds of Kenyans who struggle to identify the cause of their kidney damage. Experts warn that frequent use of strong painkillers is increasingly linked to kidney complications.

As the world marked World Kidney Day this week, health experts raised concerns over the rising cases of chronic kidney disease in Kenya, largely driven by the increasing burden of non-communicable diseases (NCDs) and self-medication.

Ahmed Twahir, a kidney specialist, warns against the use of unprescribed strong painkillers, noting that they are contributing to higher rates of chronic kidney disease among Kenyans. He identifies the leading triggers as diabetes, followed by hypertension and the use of painkillers. People with a family history of kidney disease are also at high risk.

“A lot of patients go to the counter when they feel unwell to relieve pain, but this is a major concern,” Twahir says.

“We see many patients coming in with kidney damage, especially elderly ones. As you grow older, joint and back pains become common, so it’s not unusual to find elderly people taking strong painkillers like opioids. They are undoubtedly very effective for pain, but the side effects on the kidneys are quite serious.”

However, not everyone who uses these drugs develops kidney failure.

According to the specialist, painkillers should only be taken as prescribed by a doctor, who should also conduct baseline kidney tests to prevent damage.

Damage from painkillers can occur from a single high dose or from chronic use, depending on the individual.

“We are witnessing chronic usage of painkillers, especially among elderly people with lower back pain. This is a chronic issue as you continue taking them, your kidneys gradually weaken.

‘‘It can take many years and often happens silently. By the time it’s detected, only 10 per cent of kidney function may remain, requiring dialysis,” Twahir explains.

He notes that painkillers block the formation of hormones called prostacyclin, which help widen the blood vessels supplying the kidneys

When strong painkillers reduce prostacyclin levels, blood flow to the kidneys decreases, essentially starving the kidneys of oxygen and causing cells to die.

If the damage is discovered early, fewer cells die, and kidney function may recover.

Unfortunately, kidney disease is often silent, so many people continue using painkillers for months or years. By the time symptoms appear, only about 10 per cent of kidney function remains.

The specialist explains that when kidneys reach end-stage failure —where function deteriorates over time despite medication — patients may be offered pre-emptive kidney transplants (before starting dialysis)

However, most patients seek treatment after their kidneys have already failed.

Twahir emphasises that the kidneys are vital organs: they excrete toxins, remove excess water, regulate blood pressure, strengthen bones, and stimulate red blood cell production to maintain healthy haemoglobin levels.

He warns of a rising number of kidney cases, driven by increasing hypertension, overweight, and obesity.

Because chronic kidney disease is silent, most patients only seek treatment when symptoms appear, such as fatigue, leg swelling, nausea, and vomiting in advanced stages.

“We emphasise early screening, but unfortunately, up to 90 per cent of kidney function can be lost before symptoms appear. By then, it is often too late, and very little can be done,” the specialist says.

“The emphasis should be on early detection to prevent progression to dialysis or transplant,” he stresses. People aged 30 to 40 are advised to undergo baseline kidney screening, with follow-ups every four years. Those aged 40 to 60 should screen every two years.

Individuals with a family history of chronic kidney disease, diabetes, or hypertension require regular screening. 

Many people who consume herbal concoctions for detoxification are at risk of kidney damage.

Children can also suffer kidney damage, often from congenital conditions or post-infectious complications, though it is less common.

Some children develop sore throats, and their bodies produce antibodies to fight the infection.

Unfortunately, these antibodies can attack the kidneys, leading to failure before age 20 in some cases.

“Children also report kidney problems, but they are resilient. Their kidneys have more reserves, so failure takes longer to manifest. It is rare to see kidney failure in children because it progresses slowly,” Dr Twahir says.