Written for World Kidney Day: March 14, 2019
By Dr. Alok Agrawal, MD, FASN, FNKF
This year, in honor of World Kidney Day on March 14, Dr. Alok Agrawal, a nephrologist, clinical hypertension specialist, and Clinical Associate Professor at Wright State University in Dayton, Ohio, wrote about the challenges we face regarding kidney disease, particularly its relationship to NCDs and how it affects Indians. Dr. Agrawal is passionate about prevention of non-communicable diseases through lifestyle modification. Here is his blog:
Kidneys are important organs that clear toxins from the body and maintain the balance of fluids and minerals like sodium, potassium, phosphorus and calcium. Chronic Kidney Disease (CKD) results in accumulation of toxins, higher blood pressure, poor bone health, anemia, fluid retention and other medical problems involving other organs. It leads to accelerated atherosclerosis resulting in increased cardiovascular disease (CVD). Eventually, when the kidneys fail progressively (ESRD) over years, life is sustained through expensive and often suboptimal therapies like dialysis or transplantation. People undergoing dialysis often feel unwell after dialysis and have increased risk of infections.
Kidneys and NCDs
According to International Society of Nephrology, 850 million or 1 in 10 people world-wide are estimated to have kidney disease. There are 2.3 to 7 million deaths annually from lack of dialysis and transplantation, while 41 million deaths occur from all the non- communicable disease (NCDs). While it is estimated that more than 200,000 people die every year from kidney failure in India, the numbers could be much higher. In the US, the average expense for taking care of a dialysis and transplant patient is $90,000 and $30,000 per year respectively. The average expense for taking care of a dialysis patient in India is $5000 a year. Unfortunately, barriers to affordable, accessible, adequate and quality kidney care exist in India. The system cannot care for exponential increase in numbers of patients due to lack of facilities or trained medical professionals. The financial burden resulting from taking care of CKD patients will be enormous. Large number of people live below poverty line.
Most people do not realize that chronic kidney disease and cardiovascular disease (CVD) share the two most common risk factors of NCDs, namely diabetes and hypertension. These two risk factors slowly play havoc on different organs, and account for approximately 70% of the kidney disease in the adult population. Diabetes and hypertension are most often caused by obesity, a result of sedentary lifestyle and unhealthy diets. Studies show that there is a seven-fold higher risk of kidney failure in obese people compared to non-obese people.
How This Affects Indians
There is paucity of data on CKD in Indians. According to National Kidney Foundation in the US, Asian Americans are at higher risk of CKD than the Non-Hispanic Whites (NHWs). In UK and Canada, studies show higher rates of severe CKD with faster progression compared to NHWs. The MASALA study shows similar prevalence rates of CKD in Indian men living in US cities and those in Indian cities. Evidence to date confirms higher burden of CVD in South Asians, which includes Indians, in the US. It seems highly likely that there is higher rate of CKD in Indians, residing in western countries.
The alarming rate at which the number of people with diabetes and hypertension is increasing in India is bothersome. More than 60 million Indians are diabetics. By 2030, India is likely to have world’s largest number of patients with diabetes. This has resulted in more deaths from NCDs than the communicable diseases in recent times. India is on the verge of becoming the capital of CKD due to increased incidence of diabetes and hypertension.
As a physician, I have been bothered by this silent pandemic affecting millions. The simple solution to this complex preventable problem lies in addressing lifestyle behaviors like exercise and diet. This will combat obesity, diabetes mellitus and hypertension and prevent chronic kidney disease (CKD) in majority of the patients. Tobacco cessation will also help decrease the risk of NCDs.
There is need for a more proactive approach towards modifying lifestyle factors with increased activity and healthier diets at an individual or societal level. Starting very early in life sedentary life style, sugar, salt and smoking need to be avoided. Activity should include at least 150 minutes of moderate exercise per week. Diets should have a minimum of 5 servings of fruits and vegetables, and low sugar and salt foods. Healthy weights need to be maintained with balanced diets consisting of lower carbohydrate load, adequate water and regular exercise. Currently, the only cost-effective way seems to be prevention to control the silent epidemic of kidney disease.