Growing Threat

Chronic kidney disease (CKD) is a worldwide health crisis. But with early diagnosis and treatment, it’s possible to slow or stop its progression.
By Dr. M.D. Sharma

There is a rising trend in the incidence of chronic kidney disease (CKD) affecting healthcare & economics of the countries. In India, the projected number of deaths due to chronic disease was around 5.21 million in 2008 and is expected to rise to 7.63 million in 2020 (66.7% of all deaths).
The world over 10% of the population is affected by CKD, and millions die each year because they do not have access to affordable treatment. Over 2 million people worldwide currently receive treatment with dialysis or a kidney transplant to stay alive, yet this number may only represent 10% of people who actually need treatment to live.
It is estimated that the number of kidney failure cases will increase disproportionately in developing countries, such as China and India, where the number of elderly people are increasing. In middle-income countries, treatment with dialysis or kidney transplantation creates a huge financial burden for the majority of the people who need it. In another 112 countries, many people cannot afford treatment at all, resulting in the death of over 1 million people annually from untreated kidney failure.
In people aged 65 through 74 worldwide, it is estimated that one in five men, and one in for women, have CKD. Non-communicable diseases (such as heart disease, diabetes, or kidney disease) have replaced communicable disease (such as influenza, malaria, or AIDS) as the most common causes of premature death worldwide: An estimated 80% of this burden occurs in low-or middle-income countries, and 25% is in people younger than 60 years. In the year 2005, there were approximately 58 million deaths worldwide, with 35 million attributed to chronic disease, according to the World Health Organization (WHO).
In fact, the yearly incidence of End-stage Renal Disease. (ESRD) in India is approximately 150-200 pmp and diabetes is an important cause of CKD, in approximately 30-40% of the patients. Patients with CKD are more likely to die than to reach ESRD. Moreover, diabetes & hypertension both contribute to more than 60 % of CKD Prevalence. The average global prevalence values for treated ESRD (not diagnosed ESRD), dialysis and transplant patients are 280, 215 and 65 patients per million (pmp), respectively. In India, the average prevalence values for treated ESRD (not diagnosed ESRD); dialysis and transplant patients are 70, 60 and 10 pmp, respectively.
This number is increasing globally at a rate of 7% every year. It is estimated that only 10-20% of ESRD patients in India continue long-term RRT. It is estimated that in India, there are 3,500 new renal transplant+3,000 new continuous ambulatory peritoneal dialysis (CAPD) initiation+15,000 new maintenance hemodialysis (MHD) patients every year.
With early diagnosis and treatment, it’s possible to slow or stop the progression of kidney disease. We are the cheapest in the world to give CKD treatment but not all can afford. More than 20 cores people living below poverty line spend Rs 20,000 to 30,000 per month on dialysis in private sectors and 9000 to 10000 per month in public sector hospitals; it is a huge burden on patients and the system.
Moreover, the number of qualified nephrologists in India is approximately 1000 and with 700 dialysis centres and only 170 transplant centres available it is an alarming picture to manage ESRD. Early detecting of CKD by screening for kidney disease in high-risk patients, early referral to nephrologist, appropriate treatment of hypertension, diabetes and other risk factors, lifestyle modification with specific emphasis on reduction in salt intake, physical exercise, abstinence from smoking, will retard progression of kidney disease to an advanced stage. There is an urgent need for a national program to control the epidemic of non-communicable diseases like hypertension, diabetes, chronic respiratory ailments and CKD in India.
The current dependence on the private sector for treatment of kidney patients with severe renal disease needs to be reduced with infrastructure upgradation in government run hospitals to facilitate accessibility of treatment for the majority of our population who cannot afford treatment in private hospitals. Till the country is able to provide universal health coverage, state sponsored health insurance schemes like the ones in Tamil Nadu, Andhra Pradesh and Gujarat can make the renal replacement therapy affordable for the poor.

(The author is senior consultant & HOD Nephrology,
Kailash Group of Hospitals, Noida)

FATHER’S NOBLE INITIATIVE

An 18-year-old young female, a case of road side accident having head injury, was brought to Sri Balaji Action Medical Institute on 20th march 2016. After 3 days of her treatment over there, she was declared brain dead. Her father took a noble step of donating her organs to the needy ones to save lives. Her both the kidneys, liver and the cornea were taken for donation. Her father’s great initiative saved lives of two end-stage kidney disease patients who got kidney transplant at Sri Balaji Action Medical Institute under the leadership of Dr. Rajesh Aggarwal, Chief, Department of  Nephrology and Kidney Transplant. Both the recipients are doing good. Liver and cornea were taken by AIIMS for transplantation. The father’s act should be highly appreciated so that more people can come forward to donate organs to save lives of needy people.

Kidney Disease Affects Children Too
Kidney disease in children during the last two decades is increasing worldwide with poor outcome & higher cost. As per 2008 estimates, Renal Replacement Therapy in children between 0-19 yrs age across world was 9 per million (4-18 yrs). With the changing lifestyle, food habits of children, mainly fast food such as pizza, chips, pastries, tinned & canned food, kidneys gets more & more strained.
The situation becomes worse with obesity in children & lack of sports activity. In tropical countries like India, due to sore throat, skin ailments or infection from contaminated food, meat, milk preparations & dairy products & juices, bacterial toxins enter the blood with the result that red blood cells (RBC) are destroyed and the inner wall of blood vessels including of kidney gets damaged & broken RBC get lodged in the kidneys. Vomiting, stomach cramps, loose motions, becoming pale, tired & irritable are signs of acute kidney injury results, which can be treated if you consult a nephrologist in time.
This condition is called Haemolytic Uraemic syndrome. Kidney disease can affect children in various ways, ranging from treatable disorders without long term consequences to life threatening conditions. Acute kidney failure may last for a short time but can be serious with long standing consequences or may go away completely once the underlying causes have been treated. The CKD does not go away with treatment and tends to get worsen over time. Congenital disorders (CA CUT) are responsible for 2/3 case of CKD in children.
Thus kidney diseases in children can be grouped depending upon the cause

(0-4 yrs of age)
Birth defects
Hereditary cause: Child may be born with one kidney or wrongly placed kidney.
(5-14 yrs of age)
Hereditary causes
Infections
Nephrotic syndrome
Systemic Lupus Erythematosus (SLE)
Trauma/Injury/Burns/ Dehydration from vomiting and diarrhea
Urinary Blockage may be due to reflux or valve defect between ureter & bladder.
In above cases, acute kidney injury happens, but fortunately it can be curable at the initial stage. Only few cases go to permanent kidney failure. Similarly bleeding from any cause may be from trauma, burns or after surgery operation. Kidney failure can happen but it is usually temporary. Once the cause is removed & cured, kidney can be made fully recoverable. Kidney disease due to birth defects, starts from mother’s womb itself. Such child may be born with one kidney (Renal Agenesis) or born with both nonfunctional kidneys (Renal Dysplasia) or wrongly positioned to opposite side (Ectopic Kidney) or may be located below or above the normal site. These children can lead full health life but few cases can develop CKD.
Kidney disease due to hereditary causes in children come from parents’ side and handed over to child through genetic defect. Diseases like PKD, Alports Disease, Urethral Valve defect, to name a few, are commonly seen in children. PKD is not curable & so is Alports Disease but Reflux Nephropathy due to urethral valve defect can be tacked surgically.
Nephritic Syndrome, which causes swelling of legs, feet and Ankles and often swelling of hands and face, can also affect children. This can be easily diagnosed by urine for albumin test, low level of albumin in blood and higher construction of serum lipids and fat bodies in the urine. In children, this condition is usually because of allergic cause, viral interactions and even after vaccination.
In children simple tests like urine examination for uncut ratio, blood test to see how much blood the kidney filters each minute (GFR) imaging studies (USG) to see size, shape and other abnormality of kidney and finally kidney biopsy can help the doctor see the extent of kidney damage.
Diet is equally important for kidney disease in kids. There is need for avoidance of protein diet, salt, canned food, frozen/processed foods, chips and crackers, burger and pizza. Judicious use of apples, berries, pineapple, cabbage and boiled cauliflower, liquid non-dairy creams, green beans, popcorn, lemon, lime soda is recommended by doctors.