The public health priority identified by the international community of nephrologists to mark World Kidney Day 2011 is vital for advancing the campaign against cardiovascular disease. The key message is that protecting the kidneys also saves the heart. There is a lot of evidence on the link between hypertension and damage to renal function; in turn, chronic kidney disease (CKD) can produce high blood pressure; diabetes also leads to kidney damage. That is well known, but more recent data indicate that even lesser degrees of renal impairment, manifested as protein in the urine, result in elevated risk of cardiovascular disease (CVD). This is true, in some cases, even where other factors such as diabetes, hypertension, and a history of heart attack do not co-exist. The findings may be disturbing, but affordable solutions are available to mitigate the risk. Where the problem is picked up early and a treatment regimen to reduce proteinuria initiated, there is a significant lowering of CVD risk. The promise of this approach, reported in the American Journal of Nephrology in February, is immense.
The number of deaths due to communicable diseases, and maternal, perinatal, and nutritional causes is projected to decrease in India between 2004 and 2030. By contrast, cardiovascular disease is expected to kill four million people in 2030, a sharp rise from 2.7 million for the base year. This forecast underscores the need for policy initiatives to achieve a substantial reduction in the incidence of cardiovascular disease. The reported CVD link to kidney disease makes it imperative to detect and treat early. As a goal, this is eminently achievable. Large-scale screening to detect proteinuria and early identification of CKD is the first step; involvement of the general practitioner and village nurse under rural health schemes will aid this. For those who are diagnosed with renal disease, other low-cost interventions, such as control of salt in diet, and treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, can lead to a dramatic reduction in its progression. The processed food industry, which uses a large amount of salt, must be encouraged actively to participate in such a programme. The medical community has collected enough evidence to show that early detection and treatment stop individuals from slipping into irreversible renal failure. Now, it is pointing out that doing so can save them from CVD too. The agenda for prevention must get all possible support.
Keywords: World Kidney Day, cardiovascular disease, nephrologists, health issues, chronic kidney disease
In the last five years, I too have seen an increase in the incidence of Chronic renal disease in South India esp in Karnataka and Andhra Pradesh (I took premature release from Armed Forces and returned to my native place in Andhra Pradesh in 2006). The causes are many.BUT I feel the following are the preventable ones:
1. Overuse of ANALGESICS: Most of the people consume the analgesics for even minor ailments like headache due to excessive watching of TV programmes in subdued light, late partying, sitting in front of computer monitor.
2.Use of Insulin which is kept in a 'Cold' water glass as a treatment for the control of Diabetes even at the height of summer. Due to lack of refrigeration facilities, the Insulin vial is 'kept' in a glass of water and the insulin is drawn from this vial and being injected in almost all the hospitals make the blood sugar levels vary and is difficult to monitor even by the so called Diabetologist leave alone by the patient.
3.Overuse of DRUGS for each and every ailment
This is a very important public health as well as a grass root clinical problem faced by many Cardiologists. Last 5 years has seen an enormous increase in patients suffering from renal dysfunction in CAD patients. My day to day practice observation is the Serum creatinine is increasing from the range of 0.8 to 1.2 mg/dL in CAD patients to 1.3 to 1.8 mg/dL more frequently. It is our bound duty as Physicians to spread the message of preserving kidneys especially in diabetics and hypertensives. Public awareness is an important solution to this problem.
The Editorial on world kidney disease is timely.Many experts have written in eminent national and international medical journals about the hidden epidemic of chronic kidney disease.(Rao M, Pereira BJG. Chronic kidney disease in India - a hidden epidemic. Indian J Med Res 2007; 126 : 6-9./Shyam C, Dakshinamurty KV, Sreenivas V, Ram R. Chronic kidney disease: Need for a national action plan. Indian J Med Res 2007; 125 : 498-501,/Is There a Chronic Kidney Disease Epidemic? Profile of Chronic Kidney Disease in an Urban Renal Camp in Southern India, Venkata Dakshinamurty Kaligotla,1 Shyam Chirravoori,2 Malati Tangirala,3 Gangadhar Taduri,1Sreenivas Vishnubhatla,4 Ram Rapur1 Hong Kong J Nephrol 2008;10(1):27–33)Despite repeated suggestions ,there is no action plan for prevention of CKD .Facilities for management of ESRD are scant and cost is exhorbiant. Early referals to nephrologists which can delay the progression of disease is not done. Lot is desired to strengthen Physicians knowledge regarding CKD . There is a lack of data regarding load of CKD and Renal epidemiology is a neglected field.Intersted clinicians must be trained. Much needs to be done urgently .It is time to not restrict programmes for prevention of NCDs to CAD and DM only. CKD should be on agenda.
Could someone please let me know exactly which journal the cited article was from.. was it the Journal of the American Society of Nephrology and if so, which article exactly.
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