In India, the burden of chronic kidney disease is huge and rising fast. An estimated 2,00,000 new patients are added to the dialysis patients’ pool each year. Only 15,000 continue dialysis after a month into their treatment, the rest drop out due to financial challenges or because of difficulties in reaching a dialysis centre on a regular basis.
Also, patients have to do regular blood tests, take a long list of medicines daily and, follow a strict diet. Despite all this they lead a suboptimal professional, social and family life.
The way out of dialysis is getting a successful kidney transplant. However, only about 8,000 kidney transplants happen in India each year. It is very difficult finding a kidney donor from within the family. Also, there are legal formalities involved, long term success rates are still low, chances of rejection and other medical complications exist.
The cost of both dialysis and kidney transplant is exorbitant. In Mumbai, where dialysis cost is the cheapest in the country, the cost per dialysis session ranges from Rs 1,200 to Rs 2,000 in private hospitals. The patients undergo 12 such sessions each month. Added to this, is the cost of expensive medicines, tests and transport. Kidney transplant surgeries cost up to Rs 6 lakhs, and there is a recurring cost of Rs 20,000 per month lifelong.
A massive and continuous drive to educate people in both rural and urban areas about the seriousness of chronic kidney disease and adopting healthy practices to prevent this disease is of utmost importance.
Given the scenario, it is unrealistic to expect the government to bear the burden of dialysis and kidney transplant for the needy. The only way to change the grim situation is to make preventive measures our topmost priority. If we aim at building Healthy Maharashtra, we need to deal with this situation on a war footing.
To prevent kidney diseases and raise awareness, we need to know that the commonest causes of kidney diseases are diabetes, hypertension, glomerulonephritis, stones, urinary infection and indiscriminate use of pain killers and other medications.
A massive prevalence of addiction to tobacco use, sedentary lifestyle and bad food habits have compounded the problems. Added to these are unregulated use of pesticides and rampant food adulteration and air pollution in urban areas. High summer temperatures and inadequate intake of water, in addition to high content of certain minerals in water in a few regions, may also be responsible.
To achieve success implementable and sustainable efforts by government organisations, not-for-profit organisations and private entities in a consolidated manner is essential. A massive and continuous drive to educate people in both rural and urban areas about the seriousness of chronic kidney disease and adopting healthy practices to prevent this disease is of utmost importance.
These include education on importance of regular exercises, avoiding tobacco, having balanced low salt diet, drinking plenty of oral fluids, maintaining ideal body weight and avoiding indiscriminate use of pain killers and antibiotics. For those who are already suffering for diabetes and high blood pressure, keeping control of sugar and blood pressure is of utmost importance to prevent getting chronic kidney disease.
Early detection of diabetes and high blood pressure and timely commencement of treatment prevents complications of chronic kidney disease. For timely detection, we need basic tests like a BP measurement, a simple urine examination and if possible, a serum creatinine test.
The first two tests can be performed in remote areas too. Moreover, the cost of these tests is as less as Rs 50 per patient. These can easily be done annually on a mass scale. Once diabetes and hypertension are detected, implementation of simple dietary measures and inexpensive generic medications can easily control the two conditions. The expense per patient to the exchequer can be as less a Rs 50 to Rs 100 a month.
We have an excellent infrastructure of primary health centres and community health centres with nurses and doctors. We can utilise them to take these simple measures to the masses. Meanwhile, patients who are already suffering from end stage renal disease will need dialysis near home. The government is already making efforts to make a dialysis centres available in every district hospital.
We need to involve organised private players with experience in running large dialysis units at taluka places. This will ensure the state-of-the-art technology reaches rural areas. This will be possible under the Pradhan Mantri National Dialysis programme, where budget has been earmarked for free dialysis and disbursed to the state governments
For kidney transplant to be affordable, we need to encourage these surgeries in government hospitals where cost of transplant is less than a quarter of that in private hospitals.
In Maharashtra, there are good government medical colleges with excellent infrastructure for conducting kidney transplants. We need to involve doctors from private sector to conduct these transplants and be responsible for follow-up treatment.
Many senior specialist doctors from private sector will be eager to help if provided with support of good assistant doctors. Further, providing free medications to transplant patients is the key to success.
Fortunately, deceased donor kidney transplant programme is picking up in our state, and this year we are leading in the number of deceased donor transplant surgeries in the country.
The author is the Professor and HOD of Nephrology, Bombay Hospital and is the Founder Trustee of Apex Kidney Foundation