As India faces innumerable challenges in providing healthcare to its 1.44 billion people, kidney disease is emerging as an illness to reckon with. The diversity of India especially with regard to socio-economic status, literacy, food habits, cultural beliefs, and access to healthcare are all important and complex issues facing the State and central governments. A total of 2,200 kidney specialists, skewed in distribution with a majority in the four (advanced) southern States and metropolitan cities leaves a critical gap in providing timely care to kidney disease patients.
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In 2019, chronic kidney disease (CKD) was responsible for over 3.1 million deaths, ranking it as the seventh leading cause of death worldwide. The global mortality attributed to all kidney diseases is estimated to range between 5 and 11 million annually, particularly impacting low and middle-income countries (LMICs). These countries are disproportionately affected by acute kidney injury and face challenges related to insufficient access to kidney replacement therapy, including transplantation and dialysis.
Comply with treatment
The burning issues are that people with high blood pressure, diabetes and heart disease do not comply with treatment and follow up after the diagnosis is made, which more often than not, lead to complications. Therefore it is important at this juncture to spread the message of prevention; besides addressing and evaluating the disease state periodically for the success of management strategies.
Chronic Kidney Disease of unknown origin (CKDu) predominantly affecting the farming and fishing community in different geographic locations and salt pan workers calls for more research. The genetic predisposition to kidney disease is not apparent in the majority of people in India as it is different from Caucasian, Africans, Chinese and Japanese ethnic groups. A separate forum for this should be constituted and diagnosis with management strategies should be implemented.
Thousands of Runners participated in a Kidney Run to Promote Kidney Health Awareness on World Kidney Day in Hyderabad on March 10. | Photo Credit: Nagara Gopal
As a renal community we, at Tanker Foundation, become aware that early-detection focussed programs can identify large numbers of patients with undiagnosed kidney diseases, with minimal interventions, which are cost effective. We have a moral and ethical imperative to advocate for the implementation of such programs. How can we deliver our message of prevention globally. Ignorance about kidney diseases is the greatest challenge we face. Surveys have shown that less than 5 % of the populations knows where the kidneys are located in the body. This ignorance spills over into a reluctance to seek treatment on time, eventually leading to a preventable death.
Management strategies for non-communicable Diseases such as diabetes, and hypertension include counselling, nutrition, medical therapy and drugs. The newer drugs for slowing down the progression of diabetic kidney disease are available in India and marketed by many pharmaceutical companies. These drugs are called as SGLT2 inhibitors such as dapagliflozin, canagliflozin, enpagliflozin which also protect the heart. The RAAS blockade is an effective treatment modality with telmisartan, losartan and olmesartan. The introduction of a new drug, Finerenone, which is a mineralocorticoid receptors antagonist is useful in slowing the progression of kidney and heart diseases.
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Effective blood pressure control with different group of medications to <130/80MMHg is a very useful measure to slow down kidney disease progression and heart failure and stroke. Also exercise and appropriate food intake to reduce weight (measured as body mass index >22.9kg/m2 ). The use of alternate medications and continuous consumption of Non Steroid Anti Inflammatory drugs as painkillers and proton pump inhibitors such as pantoprazole for over 3 months are not advisable unless absolutely necessary. There is a trend of buying over the counter, the afore mentioned drugs, which should be discouraged. Individuals who are working under direct heat in the open should reduce exposure to the sun in summer and consume salt and fluids to prevent dehydration and hence, kidney injury.
Handheld devices
Small handheld devices estimate serum creatinine using a drop of blood in 40 seconds. By deploying these tools in the community, visits to hospitals and franchised laboratories can be avoided. Using this tool in the 30,000 odd primary health care centres in India will boost detection of kidney disease and its management through simple protocols. Though drugs are provided free of cost in government facilities, cost and supply continue to be deterrents for poorer people. ‘Equity of kidney care’ therefore is an appropriate slogan for (World Kidney Day) WKD 2024. It will serve to spread awareness on treatment of kidney disease caused by NCD.
Masomi Nangaku, president of the International Society of Nephrology, and Latha Kumaraswami, president of the International Federation of Kidney Foundations – World Kidney Alliance, the two organisations that lead the World Kidney Day campaign, emphasise that overcoming barriers to optimal medication practice pose multifaceted challenges: including economic burdens, limited access to affordable treatments, gaps in disease knowledge, inadequate focus on prevention and early diagnosis, challenges in medication adherence, global policy gaps, a shortage of primary care professionals, and the harmful impact of patient misinformation. “Addressing these issues is essential to ensure fair access and promote a culture of well-informed and effective medication management,” they said.
The first World Kidney Day was held on March 9, 2006, and was celebrated in 45 countries. The events held to commemorate the day include walkathons, marathons, street performance by children, adults and celebrities, screening programs, educational seminars and media interviews. Tool kits made available to nephrologists, renal organisations and all others affiliated organisations contain suggestions for events, posters and media releases in different languages. People should be encouraged to ask “Are your kidneys ok?”
The World Kidney Day slogan in 2024 is ‘Advancing Equitable Access to Care and Optimal Medication Practice’. In this mission, the kidney community worldwide including physicians, scientists, nurses, patients, other healthcare providers, administrators, health policy experts, Government officials, local, regional and national kidney organisations and foundations should be in the forefront to spread the message. Everyone has to be an outspoken advocate for patients to provide equity of kidney care to all. The epidemic of diabetes, hypertension, heart diseases, obesity, lack of exercise, use of alternative medications and lack of knowledge and follow up of those with prior kidney disease or family history of kidney diseases are all drivers for kidney disease and progressions.
The message of World Kidney Day is, kidney disease is common, harmful and treatable. The platform by the Ministry of Health of Tamil Nadu to provide - Makkalai Thedi Maruthuvam - is a great initiative for the detection of both non-communicable (NCD) and communicable disease such as Tuberculosis and other chronic infections which can have an impact on kidney functions.
With all these initiatives the future looks bright for kidney disease patients in India. The WKD will definitely accelerate the knowledge base every year and will help platform common people.
(Dr. Georgi Abraham is Founder Trustee, TANKER Foundation and Consultant Nephrologist & Transplant Physician, MGM Hospital, Chennai. Latha A. Kumaraswami is Managing Trustee, TANKER Foundation and President, International Federation of Kidney Foundations- World Kidney Alliance. )
