Tamil Nadu is grappling with a rising burden of kidney disease, doctors say. To what extent is this reflective of a broader public health problem facing India?
Chronic kidney disease (CKD) affects 65,000 patients in Tamil Nadu, medicos speaking at an event in Madurai said yesterday. Of these 65,000 kidney disease patients, 15,000 are in need of advanced medical care.
Today on World Kidney Day, which takes place to raise awareness about the importance of kidney health and about kidney disease, we reflect upon its prevalence, morbidity and mortality in India.
“The burden of kidney disease lacks precise definition and is often ignored in the face of persistent challenge posed by communicable diseases”
Across India, the burden of kidney disease lacks precise definition and is often ignored in the face of persistent challenges posed by communicable diseases. However, kidney disease is believed to affect one in every ten Indians and almost five lakh Indians are believed to be in need of treatment with dialysis. Overall, kidney disease is believed to be the eighth leading cause of death in the country.
Concerningly, cases of kidney disease are on the rise. In 2016, it was reported that the number of kidney patients had doubled in the past fifteen years.
Kidney disease’s rise in India is being fuelled in large part by the nation’s rising rates of other noncommunicable diseases (NCDs). The event in Madurai spotlighted this, noting that two thirds of Tamil Nadu’s CKD cases could be linked to NCDs such as hypertension and diabetes. This is reflective of a national trend. Research links between forty and sixty percent of overall CKD cases in India to diabetes and hypertension.
This is concerning news as rates of both conditions are projected to rise to astronomical proportions in the coming years. 25.3 percent of Indians are believed to live with hypertension at present, translating to 207 million hypertension patients nationwide. In 2016, hypertension contributed to 1.63 million deaths. Diabetes, meanwhile, claims the distinction of being India’s fastest-growing disease. Housing an estimated 72 million cases of diabetes in 2017, India could witness a dramatic rise in the number of diabetics to 134 million by 2025.
“As cases of diabetes and hypertension rise, cases of kidney disease will follow suit”
The implication of this is that, as cases of diabetes and hypertension rise, cases of kidney disease will follow suit. There is a grim reality attached to this possibility. Already, it is a struggle for kidney disease sufferers to avail treatment. More than fifty percent of CKD patients are seen when their disease is at an advanced stage, due to the obstacles they face when accessing care. Given the reality that just 1,850 nephrologists service the entire population of India, it is easy to see why this is the case.
India’s significant burden of kidney disease means almost 220,000 cases of end-stage renal disease (ERSD) are diagnosed every year. ERSD is the final stage of CKD, the point at which the kidneys are beginning to fail. Patients at this stage often require dialysis, but a mere thirty percent of patients who need dialysis in India can avail it. Of those who do receive dialysis, only ten to twenty percent continue with treatment – often due to issues associated with affordability. Limited availability of dialysis often forces many patients to turn to the private sector, incurring massive out-of-pocket expenditure as a result.
Even today, over ninety percent of patients requiring renal replacement therapy die because of inability to afford care. Hemodialysis is the most common modality followed by transplantation. Peritoneal dialysis is a distant third. India is estimated to have about 120,000 patients in need of such interventions.
“India suffers from a crippling shortage of organ donors to the extent that a black market thrives due to the desperation of some patients for a transplant”
The rising burden of CKD means there is a significant demand for kidney transplants in India. However, India suffers from a crippling shortage of organ donors to the extent that a black market thrives due to the desperation of some patients for a transplant. This leads to cases of the kind seen recently in Delhi, where a kidney racket was shut down after making a lucrative trade convincing donors to sell them their organs.
Kidney disease, as a public health issue, is often overlooked in comparison with other NCDs such as cancer and heart disease. Yet it is clear that it takes a significant toll on public health in India and that the need for many kidney disease patients for treatment and screening goes unmet. Encouraging preventative measures and raising awareness on observance days such as today will go some way towards highlighting the condition. However, there must be a sustained effort to make sure there is sufficient awareness of kidney disease – and that patients who need treatment can avail it.