CHENNAI : The first ever World Kidney Day, to be observed on March 9, is a significant milestone in pushing forward the agenda of bringing into focus a rapidly advancing disease: kidney failure.

With over 1.5 lakh persons suffering from End Stage Renal Disease each year in India, the need to screen and detect patients with kidney disease as early as possible cannot be overstated, Rajan Ravichandran, nephrologist and director, Madras Institute of Nephrology, Vijaya Health Centre, says. The need to target high-risk individuals — people with diabetes and/or hypertension, who have close relatives with hypertension to seek evaluation and expert advice on how to manage the disease.

"About 50 per cent of my dialysis patients are diabetics and 75 per cent of transplantees are diabetic," Dr. Ravichandran adds. In addition, about 15 per cent of the population suffers from hypertension. Of these, 50 per cent will acquire renal failure and a similar percentage will suffer from cardiac problems. "ESRD will be soon be an epidemic, following up on the diabetes and BP epidemics," he said.

"We are now seeing patients in the 25-30 age group developing kidney failure," said P. Soundararajan, head of nephrology, Sri Ramachandra Medical College. Over the next 20 years it is expected that in India alone over 25 million people will develop kidney failure.

Dialysis

Affordability remains the stumbling block for more patients getting access to treatment. Dialysis facilities are far too limited in proportion to the need and the costs are beyond the reach of a majority of patients. Tax structures have also made India one of the few countries where home dialysis is costlier than haemodialysis. Hardly 22.5 per cent of patients requiring dialysis receive treatment and a whopping 60 per cent of patients who start dialysis suspend the treatment as they are unable to afford the programme. In over 90 per cent of people developing kidney failure in India, the outcome is death. In 2004-05, it is estimated that over 1,00,000 people died due to kidney failure.

Catching them early is a sure way of ensuring the patient does not deteriorate to ESRD, after which , dialysis and transplantation are the only solutions. " and significantly lengthen the time required to reach the stage of dialysis or renal transplantation," he said. Also, better control of these lifestyle diseases, along with periodic testing, would help keep the disease at bay. Early detection could enable the physician to handle kidney disease with medicines, the costs of which will amount to less than one per cent of the cost of dialysis or transplantation.

Any person who is over thirty, has diabetes, high blood pressure or under medication for a long while must get his urine tested for albumin every year, Dr. Ravichandran said.

Any unusual levels in the urine should raise suspicion; the causes must be examined and further tests done to rule out kidney disease.

In Japan, every child who goes to school is subjected to a urine-albumin check. Similarly, such tests could be introduced at the point of entry into college and workplace, besides following it up with regular updates, he said. An albumin test could cost between Rs.100 and Rs.200 at private clinics, but it could be much lower in subsidised settings or the Government hospitals.

With transplants involving unrelated donors virtually grinding to a halt following a tightening of laws, promoting cadaver transplants could provide the solution to thousands of patients waiting for a renal transplant.

"The Government sector needs to network with NGOs effectively and upgrade itself to perform cadaver transplants," said Dr. Soundararajan. There also needs to be a national programme for prevention and treatment of kidney diseases.

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