World Kidney Day pointers: ‘Prevention can Win Battle against Kidney Disorders’

New Delhi: Less than 10% of the patients who develop kidney failure can afford to get treatment in the country, prevention is the best possible answer. An estimated 3.5 -4 lakh new kidney failure cases are detected every year, of which less than half can avail themselves of dialysis, a situation that is grimmer in rural areas with limited centres.
Over 62% of Chronic Kidney Disease (CKD) results from diabetes, hypertension and obesity in India.
The prevalence of CKD and Diabetic Retinopathy (DR) increases proportionally to the disease duration in Type 2 Diabetes.
There is no doubt that the high prevalence of the Indian population being diabetic and hypertensive. with poor control rates are fuelling this burden of CKD and the catastrophic health expenditure on individuals and health system.

Non-Communicable Diseases (NCD) care at the primary care-level is inadequate in many states of the country.

CKD has become a common but under-diagnosed problem.
Research studies have shown that 1 out of 10 adult people worldwide have this disease. In the early stages, it is a silent disease and hence diagnosis is often delayed. If left untreated it can be deadly not only rapidly progressing to end stage renal disease but also causing damage to other organs notably the heart.

Nearly 2 lakh patients die every year in the country due to a lack of awareness of kidney disease. It is the responsibility of governments as well as physicians to provide awareness, support, and reassurance to those people who are suffering from kidney disease to bring hope to life.

As per the Global Burden of Disease (GBD) study of 2017, approximately 843.6 million individuals worldwide were reported to have CKD. In 2016, an estimated 1.2 million persons died due to CKD, and it is forecasted that approximately 2.2–4.0 million lives will be lost to CKD by 2040.

CKD and diabetic retinopathy share common risk factors such as smoking, poor glycemic control, systolic hypertension, or dyslipidemia. Development of DR may predict development and progression of CKD.

Early detection allows for better disease care and management to help prevent morbidity and mortality, and also improves cost effectiveness and sustainability. Inspire of recent advances in diagnosis and management, kidney disease related mortality continues to increase yearly and is projected to be the 5th leading cause of death by 2040.

The change in burden of CKD from 1990 to 2016 in terms of incidence, prevalence, death, and disability adjusted life years (DALYs) showed an alarming rising trend with CKD incidence increasing by 89%, prevalence by 87%, death due to CKD by 98%, and DALYs by 62%. This trend is driven partly by population growth, increased life expectancy and an aging population.

CKD presents an elevated risk of developing cardiovascular disease (CVD) and is also an independent risk factor for cardiovascular events.

Poorly informed public and patients find it challenging to access scientifically authentic and validated information regarding treatment. This is especially true for developing countries like India where there is a proliferation of quacks and untested therapies and regulatory mechanism are lax.
A significant number of affected people often land in the hands of these quacks, losing precious time as well as money. The widening knowledge gap is stifling the fight against kidney disease, and increasing the inherent associated mortality.

General public mast adopts healthy diet and lifestyles (access to clean water, regular exercise, healthy diet, avoid smoking) to maintain good kidney health, preserve kidney function longer in those with CKD, and increase overall general awareness of the importance of kidneys.
There is a need to educate and encourage primary care physicians to improve their recognition and management of patients with CKD across its entire spectrum from prevention and early detection of CKD to its secondary and tertiary prevention and kidney failure care.
Need to integrate CKD and kidney failure prevention into national non-communicable disease programs for comprehensive and integrated services, which are essential in improving the early detection and tracking of kidney care at country level.

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*Dr. Narresh Purohit-MD, DNB, DIH, MHA, MRCP(UK), is an Epidemiologist and Advisor-National Communicable Disease Control Program of Govt. of India, Madhya Pradesh and several state organizations.)