Chronic Kidney Disease epidemic: boost healthcare infra

Non-communicable diseases (NCDs) pose an increasingly large threat to the world today. What is worrying is that the highest rate of increase in NCDs is currently seen in low- and middle-income countries such as India.

Among other NCDs, Chronic Kidney Disease is proving to be one of the most common and most threatening health concerns. India has witnessed a sharp rise in the incidence of End Stage Kidney Disease (ESKD) which is currently at 229 per million populations. This means that more than two lakh cases of ESKD get added every year.

There are several factors contributing to the increasing incidence of CKD in India; diabetes and hypertension being the two major causes. Apart from this, relying on processed foods, indiscriminate use of antibiotics, painkillers, unhealthy diet and lack of exercise are some of the major factors leading to a rapid rise in kidney diseases.

India cannot afford such an alarming rise of CKD and ESKD patients. The only practical solution to the problem is prevention and early diagnosis. Since the risk factors for CKD are well-known, it is important that healthcare programmes identify people with one or more risk factors and then work persistently to ensure that progression to CKD is prevented or at worst delayed. Once CKD is detected among the population, steps should be taken to delay progression of the disease to a stage when Renal Replacement Therapy may be needed.

In India, general practitioners have a significant role to play in the diagnosis and management of CKD.

Since the number of nephrologists in the country is very low (only about 1,500), not every person diagnosed with CKD has access to a nephrologist. In such cases, proper management of the patient rests on the general practitioner.

Structured training and published guidelines for such management become invaluable to ensure this happens in an effective manner.

Apart from general practitioners, healthcare infrastructure in the country needs to be improved to deal with this problem. Primary Healthcare Centres need to be equipped to identify and manage basic illnesses. These PHCs should be able to detect diabetes and hypertension among other common conditions.

Such PHCs can refer severe cases to a bigger hospital where more complicated issues are addressed. Tertiary-care hospitals can then refer cases from these district hospitals for major surgeries and other procedures. Such a pyramidal structure is the only way this large problem can be addressed effectively.

India has about 2,500 dialysis centres with about 20,000 machines serving one lakh patients today. About 955 of these patients are estimated to get haemodialysis while the rest get peritoneal dialysis. Only about 3,500 kidney transplants are done annually in the country leaving the rest waiting, often life-long for a second lease of life.

Way forward

The government has recently initiated several measures to treat chronic kidney disease in India. With an aim of establishing haemodialysis units in every district of the country, the ambitious Pradhan Mantri National Dialysis Programme has endeavoured to provide dialysis free of cost to the poor last year. The PPP (Public Private Partnership) model that is being adopted for this programme will help people get quality dialysis and have a good quality of life ahead.

The Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat scheme announced in this year budget is also another step in the right direction. By providing health coverage up to Rs 5 lakh per family, the government has taken a major step towards the eventual goal of Universal Health Coverage. This scheme should help the poor manage their health in a cost-effective manner.

Flagged off this week, the scheme is said to provide public-funded medical insurance to 10.74 crore poor families and cashless health benefits for 1,350 procedures. However, it is anticipated that the programme is implemented in a transparent, efficient and effective manner to bridge the wide gap between what is needed and what is actually available in the healthcare industry.

A multi-pronged approach is what is required to manage the CKD epidemic that is about to hit us. Strengthening the Primary Health Centres, focusing on early diagnosis, management of diabetes and hypertension and providing quality dialysis centres would be a good start.

(The writer is founder & CEO, Nephroplus)