Why Kidney Failure is on the Rise in India

The commonest causes of kidney failure are Diabetes Mellitus (DM) and High Blood Pressure. Patients with DM develop kidney failure late, after 10-15 years. If they are not managed properly, they develop kidney failure earlier. Incidence of DM has gone up many folds in India in the last two decades. Delhi & NCR have the highest number of DM in the world. The best way to save kidneys in such patients is to have good control of sugars, Blood Pressure and use of drugs like Angiotensin Converting Enzyme (ACE) inhibitor & Angiotensin Receptor blocker (ARBs). This way, kidneys are saved and all together if these precautions are taken, there is slowing of progression of kidney failure and other complications of DM.

Control of sugars itself is a challenging task. There is a need for self-education and awareness among the patients and among all medical & paramedical staffs involved in the care. Other most important thing to mention is Coordination among all physicians and specialist involved in the care. First, a GP sees patients with DM. Then he should refer the patients to specialist for good control of sugar, who gives treatment. In case of Type I DM, they advise them to take insulin. People have the perception that insulin is harmful and when patient goes back to GP he request him for a change to tablets-oral agents for control of sugars, which is easily done without realising that patient is going to have problems and other complications of DM, if he does not take insulin.

Specialist who treat DM monitor the sugars and some time forget to monitor other parameters like blood pressure and kidney functions. If they are not looked after well patients lands up in kidney failure sooner than expected. Ideally, all of such patients should be referred routinely to Nephrologist who will take preventive measures. However, unfortunately patients are referred when their kidney functions are impaired and some time they are referred very late.

Infact, there should be coordination between all specialist looking after such patients who have multi organ involvement. However, presence of Super Specialists in India is new phenomenon. Unfortunately, coordination is lacking. There is requirement of faith and coordination among all specialists looking after a particular patient. Due to lack of coordination, patients are suffering and they land up in renal failure earlier than expected.
Those patients who have slightly abnormal kidney function have other problems like high blood pressure. Nephrologists’ best manage such patients. Cardiologist best manages those who have heart problem like Coronary artery disease.

Other causes of kidney failure are high blood pressure, Chronic Glomerulonephritis and kidney stones. Analgesics (pain Killer) medicine can harm kidneys. Whether adulterations in drinks and food items can lead to kidney failure is an important issue in developing countries like India. We read in Newspaper and watch in TV about adulterations. All of the eatable items taken are metabolised in liver and then excreted from the kidneys. Therefore, chances of damage to such organs are very likely. To prove this, there is need for research in this area. We do not know yet whether this is a cause of rise in kidney failure in India.

Dr. Q. Hasnain, Senior Consultant Nephrologist  with B.L. Kapur

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