World Kidney Day: Expert says CKD is a problem of epidemic proportions in India, suggests preventive measures


New Delhi: Our entire body consists of several vital organs that play a specific role in keeping us healthy. If one of these organs becomes inefficient or ineffective, we may find ourselves facing some or the other health issue. One such organ is the kidneys, and kidney diseases and disorders are more common than we think. The kidneys perform various functions in our body which include filtering blood from toxins, balancing electrolyte levels in the body, controlling blood pressure, and increasing the production of red blood cells.

World Kidney Day is celebrated on the 2nd Thursday in the month of March, which falls on the 12th of March, this year. It is observed as a global health awareness campaign to focus on the importance of kidneys and reducing the frequency of kidney diseases in patients worldwide. On the occasion, Times Now Digital talked to Dr Manoj K Singhal, Director, Nephrology and Kidney Transplantation at Max Super Speciality Hospital, Vaishali, who spoke to us about the frequency of kidney diseases, the seriousness of the issue, and how to prevent them. Below are the excerpts from the interview.

(Dr Manoj K Singhal, Director, Nephrology and Kidney Transplantation at Max Super Speciality Hospital, Vaishali) Anushree Gupta: World Kidney Day is being observed with the theme ‘Kidney Health for Everyone, Everywhere’. What do you think about the level of awareness, and access to people in India when it comes to kidney diseases?

Dr Manoj K Singhal: Chronic kidney disease (CKD) is a devastating medical, social, and economic problem for patients and their families. There is a severe lack of awareness with reference to kidney disease in our country. The public is becoming aware of the dangers of high BP and of cardiac disease, but the majority think that kidney disease is something you think about when you develop back pain or pain while passing urine. Of more than 100 million people (7% of Indian adults) estimated to have CKD, at least half of those with severely reduced kidney function but not on dialysis are not aware of having CKD. Most (96%) people with kidney damage or mildly reduced kidney function are not aware of having CKD. About 61% of patients with CKD present to a hospital with life-threatening complications requiring immediate dialysis. Late presentations lead to a faster progression of co-morbid conditions, increase the cost of therapy, and worsen overall patient survival. There is a huge need for more screening programmes for the presence of kidney disease and a greater emphasis on public education.

Anushree Gupta: There is a myth that kidney diseases are a very rare condition. Exactly how common are kidney diseases and what are the most common causes that lead to them?

Dr Manoj K Singhal: In many countries, chronic kidney disease is now among the top five causes of death. In India, Global Burden of Disease (2015) ranks chronic kidney disease as the eighth leading cause of death. In the absence of a renal registry, the exact disease burden of CKD/ESRD in the Indian population cannot be assessed accurately. In a population-based study from North India, the prevalence of CKD in India was estimated to be 785 per million population and the incidence of ESRD is 160 pmp. The commonest cause of CKD was diabetic nephropathy responsible for 41% cases. Another study from south India reported prevalence of any type of renal disease as 0.68% (680 pmp) and ESRD as 0.16% (160 pmp). This study also evaluated diabetes and hypertension, the two major risk factors for CKD. Another population-based study from central India determined the crude and age-adjusted ESRD incidence rates at 151 and 232 per million populations, respectively. It would mean that about 220,000-275,000 new patients need dialysis/transplant every year in this part of the world. It is estimated that there are about 55,000 patients on dialysis in India, and the dialysis population is growing at the rate of 10-20% annually. Hence, CKD is a problem of epidemic proportions in India, and with an increasing burden of diabetes, hypertension, and growing elderly population it is going to increase even further.

Anushree Gupta: Who is at a high risk of kidney diseases? How can these people reduce the risk?

Dr Manoj K Singhal: Adults with diabetes, high blood pressure, or both have a higher risk of developing CKD than those without these diseases. Other risk factors for CKD include heart disease, obesity, and a family history of CKD. Neglected kidney stones, over the counter availability and frequent use of certain drugs and toxins (e.g. painkillers, certain antibiotics and radiographic contrast agents) are other common risk factors. People with diabetes or high blood pressure should talk to their doctor about treating these conditions to keep their blood sugar and blood pressure under control and lower their risk for kidney disease. People may also address these risks through lifestyle changes, including making healthier choices about what they eat and drink, regular exercise, and avoiding smoking.

Anushree Gupta: How often should people get themselves tested for kidney diseases? Is the process long and costly?

Dr Manoj K Singhal: People with CKD may not feel ill or notice any symptoms. The only way to find out if you have CKD is through specific blood and urine tests. These tests include measurement of both the creatinine level in the blood and protein in the urine. These are simple, inexpensive tests available in most of the labs. People at high risk of developing kidney disease should get these tests once every 6 months or a year. If there is an abnormality in the test results, patients may seek an opinion from specialists. The detection of CKD in its early stages is critically important for two reasons. There are therapies that can effectively slow the progression of most forms of kidney disease. The earlier these protective therapies are used; the greater is the benefit to the patients. Most of the complications of kidney failure, e.g., bone disease, anaemia, heart disease and malnutrition start developing in the early stages of kidney disease and are a major cause of suffering and death in these patients. It is crucial to prevent the development of these complications staring from the early stages to improve the outcome in the later stages.

Anushree Gupta: What is dialysis, and who needs it? What are the other treatments for kidney diseases?

Dr Manoj K. Singhal: When the kidneys are near the end of their function (less than 10% of normal), either dialysis or transplantation is needed. This stage is also called End-Stage Renal Disease (ESRD) or CKD stage 5. Dialysis cleans the blood and removes waste products and excess water from the body. Normally, healthy kidneys do this work. Sometimes dialysis is temporary if there is an acute insult to the kidneys, which is likely to recover once corrected. However, when the loss of kidney function is permanent, the patient must continue to have dialysis on a regular basis. The only other treatment for kidney failure is a kidney transplant. There are two types of dialysis: haemodialysis and peritoneal dialysis. A kidney transplant is often the treatment of choice for kidney failure. Compared with dialysis, kidney transplant is associated with a better quality of life, lower risk of death, and lower treatment cost. Some people may also benefit from receiving a kidney transplant before needing to go on dialysis, a procedure known as preemptive kidney transplant. The benefits of preemptive transplant include a lower risk of rejection of the donor kidney, and avoidance of dialysis and its related complications. These benefits are especially significant among children and adolescents with end-stage kidney disease.

Anushree Gupta: What are some preventive measures that you would suggest to reduce the incidence of kidney diseases?

Dr Manoj K Singhal: You are more likely to develop kidney disease if you have diabetes, high blood pressure, heart disease, or a family history of kidney failure.

  • Early kidney disease may not have any symptoms, so getting tested may be the only way to know your kidneys are healthy.
  • If you have diabetes, high blood pressure, or heart disease, the best way to protect your kidneys from damage is to manage these conditions.
  • Eat healthy meals, and cut back on salt and added sugars.
  • Drink enough water.
  • Make physical activity part of your routine and aim for a healthy weight.
  • Drinking too much alcohol can increase your blood pressure and add extra calories, which can lead to weight gain.If you drink alcohol, limit yourself to one drink per day if you are a woman and two drinks per day if you are a man.
  • Limit over-the-counter pain medication.
  • Stop smoking.

Anushree Gupta: Thank you.

(Disclaimer: The views expressed by the author are personal and do not in any way represent those of Times Network.)

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