The Grenada National Patients Kidney Foundation (GNPKF) was established in 2007 with the primary aim of funding the dialysis treatment of Grenadian kidney failure patients, each of whom is living with a life threatening condition. GNPKF is a Registered Charity (No. 97/6091) in Grenada, Cariacou and Petite Martinique, working with the Ministry of Health, health professionals and other agencies to improve the provision of care for individuals who are faced with the challenges of living with renal failure.

The rate of individuals living with kidney disease and kidney failure in Grenada is increasing while resources remain limited. There are, at present, only two dialysis machines on the island. Until the formation of GNPKF, there was no means of funding the treatment of patients on a regular basis. The Government of Grenada makes a small contribution to the cost of treatment of patients in need and plans to increase dialysis resources to patients in the long run.

Patients with end-phase (stage 5) Chronic Kidney Disease require a minimum of 3 dialysis treatments per week in order to be able to survive. The procedure is extremely costly - around EC$756 per patient per dialysis treatment or EC$9,828 per month per patient. Currently, GNPKF is only able to fund 1 or 2 treatments per week for 3 patients, with 2 or 3 additional patients needing treatment soon. The Foundation has been able to treat 10 patients, including one who was helped with peritoneal dialysis. Unfortunately, 3 of these patients have died - their deaths at least partly attributable to the limited dialysis available to them.

• To reduce the number of persons suffering from Chronic Kidney Disease (CKD), and to improve the quality of life for people living with the disease in Grenada, Cariacou and Petit Martinique;
  
  
• To make treatment for CKD available to all individuals who can benefit from it, need it and want it;
  
  
• To ensure that treatment and support services for CKD are delivered in a consistent and cost-effective manner throughout Grenada;
  
  
• To promote primary healthcare through education and public awareness activities;
  
  
• To raise funds for the treatment and research of CKD, and to provide training for medical professionals working with CKD patients;
  
  
• To support the development of high-quality patient support services - working together with other organisations and the Ministry of Health.

• To provide a portion of the financial cost of treatment for over 10 kidney patients;
  
  
• To raise EC$1.5 million in 5 years and establish a Kidney Trust Fund for Grenada;
  
  
• To develop a National Renal Registry as a tool for providing a high standard of care for all kidney patients;
  
  
• To establish a GNPKF office for administration, as a resource centre and to provide counselling support for individuals, families and friends.

The burden of renal disease is large. The number of people with End-Stage Renal Disease (ESRD) requiring renal replacement therapy continues to rise worldwide. There are now around 1.5 million dialysis patients around the world. It is estimated that there are over 300,000 dialysis patients in the US, 35,000 in Canada and almost 250,000 in Europe.

A study of several countries in the Caribbean by the Caribbean Institute of Nephrology (University of the West Indies) indicates that there is an increasing number of persons with ESRD in the Caribbean. They conclude that it is important to have a Caribbean renal registry in order to perform international comparisons in renal epidemiology. The registry will monitor the incidence and prevalence of Chronic Kidney Disease (CKD) or ESRD, its causes and emerging trends. It will help with the determination of the burden of kidney disease in the region and inform healthcare planners and policy formulators. The report concluded that hypertension, chronic glomerulonephritis (GN) and diabetes mellitus were the most common causes of ESRD across most of the English-speaking Caribbean. They also reported that peritoneal dialysis was only offered on some of the islands and kidney transplantation was rarely reported. The data also indicated that more males than females were on long-term renal replacement therapy on most of the islands.

A normally functioning kidney removes waste products and excess fluid from the body. Individuals with chronic kidney failure, termed End-Stage Renal Disease (ESRD), have a chronic loss of kidney function. For these individuals, on-going dialysis treatment, or kidney transplantation, is required to sustain life. Chronic Kidney Disease (CKD) often results from uncontrolled hypertension or diabetes.

For those patients who are unable to receive a kidney transplant, who are on a waiting list for a transplant or whose transplant has failed, there are two options:

• Haemodialysis: This process separates the waste products and excess water from a patient's blood by use of a sophisticated mechanical filter that serves as an artificial kidney. Haemodialysis treatments average four hours a session, three times a week, and are typically administered in outpatient clinics.
  
  
• Peritoneal Dialysis: This process removes waste products from the blood by using the peritoneum, the lining that encloses the abdomen's internal organs. The treatment, generally administered by the patient, introduces a solution into the peritoneal cavity through a surgically implanted catheter. The solution remains in the body for several hours with the peritoneum acting as a dialysing membrane that cleans waste from the patient's system. With this method, patients can treat themselves at home.

Care of End-Stage Renal Disease (ESRD) patients is very costly. It is important to make dialysis affordable to patients using a collaborative mechanism of financing.

In Grenada there is one dialysis clinic which was opened as a private enterprise in 2006. With limited financial resources available to patients with ESRD and the unavailability of health insurance from government, patients have to limit the number of times they are dialysed. This also makes it difficult to keep afloat as a private sector clinic providing a critical service.

One of the more expensive medications needed by patients is Erythropoietin. Others are also needed and will of course vary from patient to patient. The average cost can be obtained in the process of developing a detailed funding plan.

Employers need to be flexible in allowing employees to work around the times of treatment. Employees need to provide a productive service during the hours available to them. The literature shows that employed ESRD patients have a better quality of life when they are employed in work that does not require a high level of physical activity.

Summary of Estimated Overall Cost of Dialysis Per Patient (EC$):

Kidney patients, their friends and families, as well as individual health professionals, have come together to establish the Grenada National Patients Kidney Foundation. With few members to date, the Foundation has done a tremendous amount of work raising funds and awareness in Grenada. GNPKF also works to stimulate interest throughout the Diaspora to support existing and future patients in acquiring optimum healthcare.

Whilst there have been many advances in renal care worldwide, in Grenada there is a shortage of renal professionals, and a shortage of resources for haemodialysis. The members of GNPKF invite Grenadians throughout the world to get involved and make a contribution, either in cash or in kind, to the work of the Foundation. We need more members and more volunteers to assist in our fundraising and public education activities.