By Dr Sudarshan Ballal,
The last two years have been the most challenging and trying period for all of us in healthcare. The Covid pandemic took centre stage many a time at the cost of non-Covid care including the care of patients with chronic kidney disease and its treatment in the form of dialysis and transplantation.
As it is, Kidney disease remains a huge burden on the society and it is estimated that about 10% of the adult population has some form of kidney disease and 200,000 people get afflicted with severe kidney disease (end stage kidney disease) every year and very unfortunately over 90% of them die due to lack of access and affordability of renal replacement therapy in the form of dialysis or transplantation. In addition to this many people die of kidney disease even before they reach late stages of kidney failure requiring dialysis or transplantation due to cardiovascular deaths which are extremely high in patients with kidney disease.
Hence in a country like ours and probably across the globe, the mantra would be prevention, prevention and prevention alone. The most common causes of kidney disease are diabetes, hypertension, glomerulonephritis, genetic diseases, drug induced kidney disease and kidney disease of uncertain origin.
Many kidney diseases are preventable if detected early and certainly the progression of kidney disease can be slowed down with good control of diabetes, hypertension, lifestyle modifications, dietary measures and avoidance of medicines that are toxic to the kidneys. A simple blood test for creatinine (kidney number) and urine test for albumin would detect most early kidney diseases. Because of poor awareness about kidney disease in the general public many of the patients that are seen in our set up come with very late stages of kidney disease and an all-out effort should be made at the grassroot level to create awareness of kidney disease especially in high-risk groups, early detection and measures to prevent progression once detected because treatment of late stages of kidney disease in the form of dialysis or transplantation is very expensive and unaffordable to the large majority of operations.
We certainly have come a long way since the first haemodialysis was done in 1961 at CMC Vellore. There are about 13,000 dialysis stations with about 175,000 people on dialysis in India now but most of them are in the metros and the cities and very few in the rural areas.
Kidney transplantation which is the best option for someone with end-stage kidney disease is now commonly available but again very expensive and beyond the reach of most citizens of the country.
With the recognition of brain death based on strict neurological criteria by the government of India in 1995, deceased donor donations have become a reality for kidney and other organ transplants though living related transplantation still constitutes the majority of the transplants. Currently, approximately 7500 kidney transplantations are performed at 250 kidney transplant centers in India. Of these, 90% come from living donors and 10% from deceased donors.
All in all, kidney disease is a common problem with over 200,000 people developing severe kidney failure every year and the vast majority are unable to have renal replacement therapy and hence the focus of the nephrology community and public healthcare system should be to create awareness about kidney disease, early detection and aggressive measures to prevent progression of kidney disease. This would help us in achieving the goal of ‘Living well with Kidney Disease’, the theme of the World Kidney Day this year.
(The author is renowned Nephrologist, and Chairman, Manipal Hospitals. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)