Demand & Supply Imbalance In Kidney Healthcare Is Significant In India: Aseem Garg

What are some major causes of Kidney failures in India?    

Kidney failures can happen due to various reasons but most common reasons of the Chronic Kidney diseases (CKD) cases in India are Type 2 diabetes and High Blood Pressure or both at the same time. CKD is very dangerous and can even cause Kidney failures. Nearly 10 per cent of India’s population suffers from Chronic Kidney Disease. Not only kidney but diabetes and high blood pressure can also cause heart disease and strokes. So, keeping your blood sugar and blood pressure is very important for a healthy Kidney as well as a healthy life.  

There are a number of other factors which can lead to serious Kidney problems such as Type 1 Diabetes which is also known as Juvenile Diabetes. It can happen to young children also. In this case, Pancreas stops producing insulin or produces very little insulin resulting in Diabetes.  Type 1 diabetes can harm major organs of the body like Kidneys, hearts, eyes, blood vessels and nerves. 

Apart from this, Glomerular disorder also affects your kidney. It affects the filtering units of Kidneys known as The Glomeruli. A person suffering from this may experience urine disorders, swelling in face, hands or legs and high blood pressure. It also affects the nephrons' blood arteries. Then, Lupus is one such disorder which can damage the Kidney big time. Infact, it is an autoimmune disorder in which the body's immune system becomes hyperactive and attacks its own organs and tissues like Kidney, skin, joints, blood cells, heart, lungs and brain. Though Lupus is quite common and easily curable but if not taken proper action, it can also trigger serious problems in Kidney and other organs.  

Kidneys can also get damaged due to overdose of some drugs like NSAIDs (Non-steroidal Anti-Inflammatory drugs) which are widely used to relieve joint pains, headaches, painful periods, arthritis and other types of pain. Though it is widely used, it can result in some serious side-effects and should be taken under proper guidance. Then cyst disorders also cause Kidney problems. In these cases, normal kidney tissues are replaced by fluid-filled bubbles. So, one should take care of their body and more importantly know about their body well and lead their lives accordingly. Knowing the exact cause of CKD might help the doctors treat it more effectively. In certain circumstances, blood or imaging tests might reveal the source of the problem whereas sometimes doctors might require biopsy of a tiny tissue sample to identify the root cause.   

Are there any other advancements happening in the nephrology sector to treat kidney failures? 

Ofcourse, a lot of technological advancements are taking place in the field of nephrology to treat kidney failures but still medication is the most preferred option apart from finding a suitable donor or going through regular dialysis.   

Though there is no cure for the last stage of CKD, one can contain the seriousness by keeping control over sugar levels, cholesterol and blood pressure which often lead to serious Kidney problems.   

How big is the gap between the demand and supply of the healthcare facilities available to patients diagnosed with kidney failures? 

Demand and supply imbalance in kidney healthcare is quite significant in India. Exact burden of Chronic Kidney diseases are still undefined in the country but as per the reports by the Global Burden of Diseases for 2019, India has 2.16 million cases of CKD and 115.22 million prevalent cases. According to reports, over two lakh patients with serious kidney disorders are added to the list every year who require transplantation out of which only around 3.5 per cent are able to get it and just 10 per cent of the patients are able to get dialysis service on time.  

This clearly reflects the lack of proper infrastructure for Kidney related treatment, and hence the demand for dialysis is growing in India. There are roughly 4950 private dialysis centres and only a handful of government-run centres. 

With the private sector taking the lead in providing the dialysis services in India reflects a low public spending by the government. Do you think a larger push needs to come from the government to tackle the current size of the patients? 

The statistics clearly show the lack of Kidney healthcare infrastructure in India. With about two lakh new patients being added to the pool of CKD every year and only around 3.5 per cent able to receive the right treatment at the time shows that a lot of work is needed in this sector. Yes, it's true that private sectors have way more dialysis centres than the Government but it is not the obvious choice for a majority of the population because of affordability. The difference in dialysis costs in private and public hospitals is massive. The difference can vary upto Rs 1000 or more. Private sectors are easily accessible and do offer better service but it is not affordable for the majority of the patients that is why India witnesses such huge numbers of kidney related casualties every year. Hence, it is quite evident that a larger push by the government to open more public dialysis centres is the need of the hour.    

Do you think the kidney failure deaths in India are greater in comparison with other low and middle level economies around the world? 

As of now, countries like Taiwan, Japan, Mexico, the United States, and Belgium report the maximum number of casualties due to Kidney problems but India’s demand for dialysis is growing at a rate of 31 percent, compared to 6 percent in the US and 8 percent in the rest of the world. As of 2016, there were approximately 13 lakh patients in India requiring renal replacement therapy with approximately two lakh new patients being added to this pool each year. As I mentioned earlier, only 3.5 per cent of CKD patients are able to get the kidney transplant on time and only 10 per cent patients have access to proper kidney dialysis care, it will not to be wrong to say that these are alarming signs for the country. We may soon leave other countries behind if proper steps are not taken immediately.  

How can dialysis become more affordable as in India many opt out of dialysis due the heavy costs involved? 

Most of the equipment required to set up a dialysis care unit are imported due to which the cost of the dialysis is quite high. The other reason is that the maximum number of dialysis units are run by private players which are not affordable for many patients. The government run dialysis care units are affordable but they are very less in number due to which a large number of patients are not able to get the treatment at these centres. Lack of nephrologists in the country has also made this service quite costly. According to a report, there are only 1300 nephrologists in India, making it more difficult for the hospitals to provide dialysis at an affordable price.  

Government should think of increasing government-run dialysis centres to make this service affordable and increasing the number of well-trained nephrologists is also important. In my personal opinion, if the equipment is manufactured locally, it will also help in reducing the cost of dialysis service in the country so the government should also think in that direction. 

What are some major steps that are needed to be taken to reverse the trend of rising kidney patients in India? 

Diabetes, high blood pressure, heart disease, a family history of kidney disease, and obesity are the main factors behind Kidney related problems. So, if we try to keep these under control, hopefully there will be a huge drop in kidney related diseases. Rather, everyone should get their complete body check-ups done on regular intervals specially Sugar levels, blood pressure, cholesterol level and other factors which are highly responsible for causing kidney problems. Nowadays, people are giving so much of time and money to their cosmetic requirements so I think getting body check-ups done should not be a big problem. Regular body check-ups are an integral part of a healthy life-style and especially for a healthy Kidney. A simple urine or a blood test can be used by your doctor to check the status of your Kidney. Other than this one should also avoid overuse of pain-killers. Excess use of pain management medicines called NSID (non-steroidal anti-inflammatory drugs such as ibuprofen) can also cause kidney diseases. Long term usage of NSIDs especially in high doses, reduces the blood flow to the kidney which causes harm to kidney tissue.