In India over the years Chronic Kidney Disease has emerged as a major health concern. Even though the overall prevalence and estimation of the burden of chronic kidney disease in the country cannot be assessed accurately since there is no comprehensive data across all categories in the country, some recent studies have shown that the approximate total number of people infected by the disease so far is about 800 cases per million population.
According to the Union Health ministry, every year 2.2 lakh new patients report End Stage Renal Disease, which leads to progressive and irreversible destruction of the kidneys.
This year, it is estimated that 229 million people have been found to have chronic kidney disease and the concern is that the numbers are likely to increase because there has been an upsurge in renal failure cases across the country.
It has been found that high blood pressure, hypertension and diabetes are the most common causes of kidney disease. High blood pressure causes over a quarter of all cases of kidney failure, whereas diabetes and hypertension account for 40–60% cases of Chronic Kidney Disease.
While Kidney infections are also linked with cardiac disease, which often leads to deaths, diabetes has also been established as the cause of around one-third of all cases and is the commonest cause of End Stage Renal Disease, which is the last stage of the disease, when the kidneys no longer support the body’s needs.
Much of these non-communicable ailments are also linked with unhealthy lifestyle such as consumption of saturated fats, sugar and high salt intake and low-in-carbohydrates fruits and vegetables are the major risk factors for hypertension. Tobacco smoking is another cause for chronic diseases.
Apart from lifestyle risk factor, there is limited awareness about the disease itself – what causes it and what steps need to be taken to prevent the public from getting this chronic disease.
Currently, due to low awareness in the public about what causes chronic kidney disease, many of them are unable to get timely treatment and care. Many do not get themselves tested at the early onset of the disease. The reason being that in most people with reduced kidney function there are no signs or symptoms so they are not aware about their health condition or the need to get themselves checked. One of the leading causes of cardiac disease is kidney infections which often leads to deaths.
If the population is made aware that even slightly impaired kidney function can cause subtle damage to the heart and blood vessels, and that they should approach their doctors, only then they will learn how to reduce heart disease risk and save their lives.
Overall, in all cases of kidney disease, preventing the causative factors, primarily diabetes and hypertension, as well as timely diagnosis are the only ways to stop the threat that kidney diseases pose.
Government indifference towards the marginalised communities.
In rural areas it has been found that the situation is grim. Chronic Kidney diseases are silent killers especially in these areas. Since majority of them reside in places, which are far away from the mainstream, the distance becomes a barrier for the families.
Also, in many parts it has been found that due to lack of health facilities, shortage of doctors and no provision for diagnosis, treatment and care as well as dialysis, these communities are highly vulnerable.
For these groups, untreated kidney failure can be life threatening. Since no surveillance has been done in these areas to understand the overall status of these groups, there is no data available about the number of people who have Chronic Kidney Disease, their mortality and morbidity rates.
To understand the scale of the disease burden in these areas, studies need to be done on these groups and also ensure that those affected by the disease get proper diagnosis and treatment on time. This can happen only when the government increases its outreach to expand access to healthcare.
Care and Treatment
For appropriate treatment of any disease, availability and affordability are two important issues. There is lack of adequate number of nephrologists in the country, especially in rural areas and district level hospitals.
To prevent and control Chronic Kidney Disease and the causative factors like diabetes and hypertension, it is imperative to provide doctors and timely diagnosis and treatment and ensure whether it is dialysis or transplants, it will be done at reasonable prices, which are the only ways to stop the threat that Chronic Kidney Diseases pose for the population.
Overall, to ensure better health care support, it is imperative that patients, especially the marginalized and the elderly, who approach the health system are given appropriate diagnosis, treatment and care, especially those with failed kidneys who require lifelong dialysis.
Apart from urine tests, patients, who have low awareness, should also be told about the importance of these tests which help to detect kidney disease at an early stage. Communities themselves through interactions should be told that those with a family history of kidney failure, recurrent urinary tract infection, diabetes and hypertension must get themselves tested periodically.
Also, those who have never been tested for any ailment, who live in far off villages and mountainous areas should also be tested routinely so that the disease burden can be identified and proper treatment provided to prevent deaths. The government has to itself reach these unreached areas only then can these neglected groups get appropriate treatment and save lives. By increasing their outreach, access to healthcare services will be easier for these communities who have so far been denied healthcare support.
Kidney Transplant and Dialysis
As for transplants, a definitive treatment for kidney failure, more than 4000 kidney transplants are performed in India every year, a majority are using kidney from a living donor.
However, many patients are unable to get transplants done since the cost is high. Currently in the private sector, each transplant costs about six to eight lakhs, which most families are unable to raise. Besides, there is also lack of donors, without which transplants cannot be done.
Apart from a few states like Tamil Nadu, Karnataka and Delhi there are very few donors for transplants, even though the Central government has passed the law for organ donation for free dialysis and transplantation for the poor. The government pays the private hospitals via a health insurance company. However, the only way equity of therapy, accessibility and cost can come down in the long run is by improving the infrastructure in the government hospitals.
There are other gaps as well. It has been found that a number of impoverished families are becoming pray to brokers who forcibly buy their kidneys and sell them to some private clinics or even those who come from other countries. Many of these people have paid with their lives since they did not receive any care after given their kidneys. While kidney donors are needed, it is also crucial that the government regulates these wrongful activities.
To address these non-communicable chronic diseases, it is imperative that a mechanism should be worked out to provide improved access to dialysis service in various states by the government. Once rolled out, it will provide huge relief from high cost and also improve access and reduce the need to travel long distances, especially for those families who live in rural areas.
This will also help the poor and impoverished families get free dialysis and transplantation under government schemes like RSBY and NHM.
Currently, the government pays the private hospitals via a health insurance company. But those who live in rural areas do not have access to insurance, so they don’t get these benefits. However, the only way equity of therapy, accessibility and cost can come down in the long run is by improving the infrastructure in the government hospitals along with increasing the work force.
For high-risk patients, early referral to nephrologist, appropriate treatment of hypertension, will prevent progression of kidney disease to an advanced stage.
Also, many dialysis centres have minimal water treatment facilities and monitoring quality of water used for dialysisis often neglected, which places the patient at risk.
To address all these matters, there is also an urgent need for a national programme to control and prevent non-communicable diseases like hypertension, diabetes and cardiovascular disease. Creating awareness in the public about proper food habits and preventing people from smoking, which are closely linked with chronic diseases like kidney, can help bring down the disease burden significantly.
Besides, instead of depending on the private sector for treatment of kidney patients with severe renal disease, government run hospitals need to be supported and provided with adequate facilities like infrastructure and adequate work force to not only facilitate accessibility of treatment but also deliver high quality care for patients since a majority of our population cannot afford treatment in private hospitals. It is also important to reduce the commercial transplantation and make transplantation affordable to all, across all categories in the public sector.
(Mohuya Chaudhuri is a journalist and researcher)