Authored Article by Dr C Kedharnath, Senior Consultant Nephrologist, Westminster Healthcare, Chennai
Due to its high prevalence, morbidity and mortality, Chronic Kidney Disease (CKD) has become one of the pressing public health issues in India. This is mostly because of lack of adequate accessibility to treatment owing to large number of patients below the poverty line, low gross domestic product and reduced allocations for healthcare. According to latest report by Indian Council of Medical Research (ICMR), the incidence of chronic kidney disease is as high as 17.2% and the number is increasing every day. This is where comes the need to realise the importance of making kidney care and treatment affordable for all. Thus, the World Kidney Day, celebrated every year on the 2nd Thursday of March, has been rightly themed as ‘Kidney health for everyone everywhere’.
Financial hardship is considered to be the major reason why most patients suffering from CKD in India do not get appropriate access to treatment. Also, dearth of adequate infrastructure, facilities and doctors in rural and semi-rural areas also add up to the concern of inaccessibility to kidney treatment in the country. There are very less number of dedicated centres for care, lack of universal access to Renal Replacement Therapy (RRT) and lack of a proper record or registry. Despite considerable medical advancements across sectors, 90% of patients with CKD that need RRT for survival are hardly able to afford the treatment and d meet fatal consequences. While some initially begin the treatment, 60% of them stop for monetary burden. Kidney transplants are often not affordable for most as the post-transplant complications can also increase the financial burden.
There are a large number of factors to be blamed for leaping prevalence of CKD in India. According to the United Nations Children’s emergency Fund data, 28% of children are below 2.5 kg at birth. Reduced birth weight, and other nutritional issues during gestation result in smaller kidney volumes at birth. Also, traditional practices of consanguinity and genetic inbreeding among certain community amp up the risk of congenital disputes of the kidney and urinary tract and obstructive or reflux nephropathy. Apart from these, poverty, poor sanitation, increasing air pollution, contamination of water, overcrowding and nephro-toxins including heavy metals and plant toxins in indigenous remedies can also cause glomerular and interstitial kidney diseases. Increasing incidence of hypertension and Diabetes in the country is also a major contributor to kidney ailments.
The most common symptoms of a chronic kidney disease, specifically kidney failure include reduced amount of urine, swelling of legs, ankles and feet due to retention of fluids as a result of inability of the kidneys to flush out water waste. Also shortness of breath, nausea, a sense or feeling of confusion, excessive drowsiness, tiredness, pain or pressure in the chest and seizures. It is essential to watch out these symptoms and opt for quick diagnosis for detecting the problem at an early stage. There are several ways by which kidney failure can be easily diagnosed. These are urinalysis or testing the sample of urine, measuring the volume of urine, analysing and examining samples of blood, imaging such as ultrasounds, MRIs and CT scans that help in providing the images of kidneys and urinary tract to detect anomalies and testing the kidney tissue samples for examining abnormal deposits, scarring or infectious organisms.
The two prevalent modes of treating chronic kidney disease are dialysis and kidney transplant. Dialysis that filters and purifies blood using a machine, cannot really cure kidney failure but enables an individual with CKD to live for greater number of years. For kidney transplant, an individual may have to wait for prolonged period of time to get a matching organ. But once done, the new kidney may work perfectly. However, the recipient will have to continue taking immunosuppressive drugs.
Prevention is better than cure. Hence, it is always wise to take measures so that falling prey to chronic kidney diseases. It is important for an individual to follow doctor’s instructions before taking over-the-counter medications. Some of the common drugs like aspirin, paracetamol, ibuprofen can result in high toxin levels and over-burden the kidneys. Also, one must prevent getting exposed to chemicals like household cleaners, pesticides, tobacco and more. Following a healthy lifestyle and maintaining healthy diet are must for keeping up kidney health.