Dr. Hari Prasad A
Kidneys are a pair of bean-shaped organs located on either side of the spine in the abdomen. Their main function is to filter the excess water and salt in the body and excretion of waste products formed in the body as a part of metabolic activities. Chronic kidney disease (CKD) is a condition developed because of long-term damage to the kidneys and major contributors to this damage are diabetes mellitus and hypertension. With the increasing prevalence of risk factors like obesity, diabetes mellitus, and hypertension, the number of patients affected by CKD has also been increasing. Noncommunicable diseases are now responsible for three-fourths of all deaths globally, up from 57% in 1990. Almost 80% of all premature non-communicable deaths are in low- and middle-income countries. CKD is one of the important contributors to the deaths in the non-communicable disease list and the numbers are increasing exponentially with each passing decade. With ~ 3% of landmass, India hosts ~ 17% of the global population, a large number of patients being below the poverty line, low gross domestic product, and low monetary allocations for healthcare have led to suboptimal outcomes in India.
According to a Global Burden of Disease (GBD) study in 2017, the global prevalence of CKD is 9.1% and it affects around 850 million people worldwide. The prevalence of CKD increases with increasing age with almost half of the population above 75 years of age having some degree of CKD. The prevalence of CKD in India according to various studies has been around 17% and among those with moderate to severe renal disease around 6%. Causes of a high prevalence of CKD in India include a high rate of Low Birthweight infants leading to smaller kidney volume at birth, high incidence of consanguinity leading to increased risk of congenital anomalies of the kidney and urinary tract, obstructive or reflux nephropathy. Poverty, poor sanitation, pollutants, water contamination, overcrowding, and nephrotoxins (including heavy metals and plant toxins in indigenous remedies) may lead to glomerular and interstitial kidney diseases. Along with these exposures, the ever-increasing group of people with diabetes mellitus and hypertension in India has led to an increase in the number of patients with CKD.
Most of the patients with kidney disease are not aware of it as they do not have any symptoms. Around 50% of patients with advanced CKD are first seen when they are about to need renal replacement therapy (RRT). This RRT is provided in the form of Hemodialysis or Peritoneal dialysis or Renal transplantation. Hemodialysis is the most common modality followed by renal transplantation and peritoneal dialysis is a distant third in India. According to an estimate, over 90% of patients requiring RRT in India die without even starting on dialysis, because of the inability to afford care. Even in those who start dialysis, 60% of them stop in between because of financial reasons. Compounding these issues are scarcity of nephrologists, with only 2600 renal specialists serving a population of ~ 1.3 billion with most of them concentrated in urban centers.
Every year about 2.2 Lakh new patients of End-Stage Renal Disease (ESRD) get added in India resulting in additional demand for 3.4 Crore dialysis every year. With approximately 4950dialysis centres, largely in the private sector in India, the demand is less than half met with existing infrastructure. Since every Dialysis has an additional expenditure tag of about Rs.2000, it results in a monthly expenditure for patients to the tune of Rs.3-4 Lakhs annually. Peritoneal dialysis (PD) providing dialysis at home is a viable alternative for a country like India. Issues of non-availability of a separate clean room for PD, and lack of clean running water for handwashing before doing a PD exchange are a few of the barriers preventing widespread use of Peritoneal dialysis. Renal Transplantation programmes offer better living standards for ESRD patients while being cost-effective in long term. This is however limited by the availability of organs for transplant, high initial costs, and the need to continue expensive immunosuppressive medications.
In view of high morbidity and morbidity including huge financial implications for management of CKD, efforts should focus on prevention and effective management of the disease. Regular screening for CKD including Blood and urine investigations in high-risk individuals, regular Blood pressure monitoring and control, Optimisation of blood sugars in diabetics, healthy and active lifestyle practices, avoidance of over-the-counter medications, and adequate hydration can help in reducing the incidence of CKD. For the patients with ESRD, establishing new dialysis facilities and increasing the number of dialysis machines, offering peritoneal dialysis for compliant patients, and encouraging renal transplant programs will be the way forward for improving the care of patients with ESRD.
(The author is a Consultant-Nephrology, Kauvery Hospitals Electronic City (Bangalore). Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com.)