Renal problems on rise

Published in The Times of India. March 7, 2007

With an estimated 1.5 lakh new cases every year, chronic kidney disease (CKD) has emerged as the third most common non-communicable disease in the country, thanks to the rising incidence of hypertension, obesity and alcoholism. As the world celebrates World Kidney Day on March 8, Times City takes a look at the problem and its possible solutions. The kidney, whose functions include maintenance of fluid and electrolyte balance of the body is intimately associated functionally with all other vital organs — so much that in international medical parlance, CKD is referred to as a diseases multiplier. It is in fact a part of a vicious circle where on the one hand CKD is a result of multi-systemic problems and on the other, it further aggravates those problems. Says Dr Sanjeev Bagai, paediatric nephrologist and head of the department of paediatrics, Rockland Hospital: "Internationally available figures for India out the incidence in adults and adolescents at one in every 10-15 people. For newborns, it is 0.1-1% which, given our population, is a huge figure. Rising maternal age has further complicated matters because many more babies now are being born with congenital kidney abnormalities. The critical part here is that awareness levels are still very low and outside major cities, the availability of diagnostic facilities is poor." The risk factors for kidney diseases are often the same as that for the heart, given that the filtration of blood in the kidney which is its primary modus operandi, depends on the same factors — arterial diameter, blood pressure and rate of blood flow — as the well-being of the heart. Doctors blame the country's rising CKD figures on rising hypertension — that causes the filtration rate to become too fast for effective purification of the blood, smoking — that is known to cause stiffening of arteries and diabetes and hypercholesterolemia which are known to be responsible for atherosclerosis. Ironically, it is only recently that the country has woken up to the CKD clock ticking away so doctors are still uncertain how much of the bloated figures are a result of better diagnostic facilities and what the real extent of the disease in India may be. Says Dr Salil Jain, consultant nephrologist, Fortis Hospitals: "It is true that risk factors for CKD like diabetes, hypertension and smoking are on the rise. But it is also true that awareness levels among doctors is much better now and we are picking up many more cases than before. It is precisely to gauge the extent of the problem that the national level committee on chronic kidney disease was recently formed. This is a registry that will give us realistic figures of whether and to what extent kidney disease is on the rise." The common symptoms of CKD are loss of appetite, frequent vomiting, frequent urination often with discomfort, recurrent fever, face and ankle swelling, weakness and anaemia, headache, nose bleeding and hypertension, rashes, recurrent abdominal pain and recurrent respiratory infections.