Prevention of CKD & Control Non-Communicable Disease

Bangalore

With WHO sharing alarming estimates that CKD would be the 5th cause of death among non-communicable diseases by 2040, KWF decided to undertake the challenge of delving deeper into areas of concern.

In March 2023, our first CME was held in Bangalore under the aegis of Indian Society of Nephrology, IMA Bangalore. The event was held jointly with NephroPlus, India’s largest dialysis service provider.

To start this initiative a Task Force was formed with Dr Sundar Sankaran as the leader and Dr Arvind Canchi as an Advisor.

Early Diagnosis & Preventive Care’ to address the growing burden of CKD

~10% of the total population suffers from Chronic Kidney Disease in India~
. ~ Each year more than 100 thousand new cases of renal failure are detected~
~Diabetes and Hypertension are the leading causes of end-stage renal failure
 ~31% of all cases of Chronic Kidney Disease are due to diabetes

In March 2023 a panel discussion was hosted with India’s finest medical experts in the field of Cardiology, Diabetology, Nephrology, and Ophthalmology to address the growing risk of co-morbid diseases such as cardiac illnesses and diabetes on kidney health. The program was organized on the occasion of World Kidney Day under the guidance of the Indian Society of Nephrology and the Indian Medical Association. The discussion focused on initiating measures for the early detection and prevention of Chronic Kidney Disease.

The program was graced by Sri. D. Randeep, IAS and Health Commissioner, Ministry of Health and Family Affairs (Karnataka), Government of India who stated, “Awareness and early screening is the key. It helps in keeping people away from ending up with CKD and finally ESRD. The dialysis demand and waiting list for a kidney transplant are alarming. This is a wake-up call for all of us to act now.”

Dr. Gurudev K C, Chief Guest and President, Nephrology, at Ramaiah Memorial Hospital, highlighted that while clinical management of CKD has been practiced widely, efforts in preventive nephrology with early intervention in people at risk for BP and blood sugar is the need of the hou

“Chronic Kidney disease has reached an epidemic proportion, and it is estimated that 10% of the population suffers from it.  Unfortunately, most clinicians spend their time in curative nephrology rather than taking preventive measures. India has a massive gap between those who have and have not.  Each year more than 100 thousand new cases of renal failure are added, and probably ten times this number goes unreported.  Renal replacement therapy, either in the form of dialysis or transplant, is available only for a fraction of this number” added Dr. Gurudev

Keeping this in mind, it was discussed that patients with diabetes or hypertension should get their health tests done, and get their creatinine or eGFR checked. This will help in determining kidney health. Several drugs are used for blood pressure control and diabetes control, which also protect the kidneys. Some of these medications protect our kidneys even if we don’t have diabetes.
Therefore, consulting the doctor is imperative.

Speaking on the condition of Hypertension, Dr. Rajan Shetty – Interventional Cardiologist at Manipal Hospital said, “Most cardiologists end up seeing 30 to 40% hypertension cases during OPDs. Therefore, it is very important to tell patients why it is important to treat hypertension. The treatment is mainly to prevent strokes, because 80% to 90% of strokes can lead to kidney disease, heart failure, and many other conditions.”

“Secondary hypertension because of obstructive sleep apnea needs to be controlled through the CPAP machine. Uncontrolled secondary hypertension could affect the kidneys, heart, and liver. It is vital to gather information on sleep patterns” added Dr. Shetty

Leading Diabetologists, Dr. K N Manohar and Dr. Bhavan on the panel focused on the fact that diabetes is the leading cause of kidney failure worldwide, and diabetes management should not only focus on controlling blood sugar but also consider other issues like hypertension, high cholesterol, kidney and heart functions, and eye diseases, calling for a shift towards holistic management of diabetes. They also emphasized the need for education on healthy living and regular monitoring of health parameters like weight, blood pressure, blood sugar, and cholesterol values. They suggested that such education should be included in school curriculums.

On the other hand, prominent Ophthalmologists Dr Santosh and Dr. Dhwani Shah stressed the importance of annual eye check-ups and the use of regional cameras that can detect changes in the retina related to diabetes, hypertension, and glaucoma.

Similarly, renowned Gynaecologists, Dr. Shefalika and Dr. Kavita Kovi stated that It is crucial for young women to be aware of the potential kidney problems that can occur during pregnancy, such as dehydration and hypertensive disorders. Regular check-ups with their obstetrician and prompt reporting of any symptoms like flank pain, recurrent UTIs, or facial swelling can help detect these problems early and prevent serious consequences. Regular ultrasounds can help detect any silent loss of kidney function early, which can be effectively treated to prevent further damage.

Furthermore, CKD patients may experience menstrual disturbances like heavy flow, painful cycles, and prolonged flow, which can be managed with safe medications. It is important to treat these symptoms to prevent anaemia, which can worsen the condition in CKD patients. Overall, patient awareness, early detection, and proper treatment are crucial for preserving kidney function in young women with gynaecological problems or pregnancy-related complications.

On the same note, general physicians like Dr. Sundar Sankaran, Dr. Anuradha and Dr. Padma also highlighted the importance of the general physician by stating that the family doctor’s role has always been largely undermined with multi-specialty taking the limelight. The family doctor who has generations of relationship with the family is ignored. However, they could be the bridge for information between nephrologists and patients. Hence, a family doctor needs to guide their patients on appropriate treatment by specialized doctors to prevent critical ailments.