Sunday, March 10, 2019

CKD in India: Early detection is the key to its prevention

Chronic kidney disease or CKD is becoming a major public health problem globally, including in India.

The exact burden of CKD in India is not known, but CKD is becoming an epidemic in the country.  The prevalence of CKD in India is estimated to be 800 per million people. Every year about 2.2 Lakh new patients of end stage renal disease (ESRD) get added in India resulting in additional demand for 3.4 crore dialysis every year.

The two commonest causes of CKD are diabetes and hypertension. With the growing population of persons with diabetes and hypertension coupled with increasing life expectancy, this number is only going to further increase.  

CKD has poor outcomes and entails high treatment costs. It is gradually progressive disease, but since it is asymptomatic in early stages, CKD is often detected when the disease is in an advanced stage and most kidney damage that has occurred is irreversible.

How well the kidneys are functioning can be estimated by the eGFR or estimated glomerular filtration rate. Based on the eGFR number, CKD can be divided into five stages.

Stage 1: Normal or high GFR (eGFR > 90 mL/min/1.73 m2)
Stage 2: Mild CKD (eGFR = 60-89 mL/min/1.73 m2)
Stage 3a: Moderate CKD (eGFR = 45-59 mL/min/1.73 m2)
Stage 3b: Moderate CKD (eGFR = 30-44 mL/min/1.73 m2)
Stage 4: Severe CKD (eGFR = 15-30 mL/min/1.73 m2)
Stage 5: End Stage CKD (eGFR <15 mL/min/1.73 m2)

Stage 3 chronic kidney disease (CKD) is the first stage that is identifiable from a blood test alone (Br J Gen Pract. 2010 Jun 1; 60(575): e266–e276). Most patients are detected at this stage of the disease. Stage 5 CKD means the patient is undergoing dialysis or needs to undergo dialysis.

In India, CKD is a part of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and noncommunicable diseases (NCDs) such as heart disease, cancer, diabetes have been in the spotlight. However, the rising incidence of CKD to epidemic proportions merits a dedicated national program for prevention and management of CKD.

There is no cure for CKD … early detection is the key to its prevention.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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