ESRD: end-stage renal disease *Others sickle cell nephropathy -2 (2.8%), ADPKD -5 (7.0%), toxic nephropathy -22 (31.0%), obstructive uropathy -20 (28.2%), chronic pyelonephritis -22 (31.0%)

This may be a huge underestimation of the true situation in rural and semi-urban communities. Patients often present late and a good number of them may not visit the healthcare facilities for several reasons including high cost of healthcare services as well as the use of alternative treatments such as herbal remedies, spiritual healing and traditional native healers⁹. The cost of management of ESRD and affordability is a concern where renal replacement therapy (RRT) is available. There is little or no social security system including appropriate healthcare insurance scheme and so patients pay out of their pockets.

Most of the prevalence studies in Nigeria were hospital based^{8, 10-11,} and of ESRD, with figure ranging from 8% to 12%. The epidemiological community based studies identified in Southeast Nigeria, however, looked at various stages of CKD in rural and semi-urban communities. One of the study documented that the overall age and sex adjusted prevalence was 11.4%, respondents ≥ 60 years was 27.8% in rural and the highest prevalence of 32.9% was observed in semi urban area¹².