World Kidney Day is a global campaign aimed at increasing awareness of kidney health amongst the general public. This year, it is being celebrated on 13th March. The theme for 2025 is “Are Your Kidneys OK? Detect Early, Protect Kidney Health.”
The prevalence of Chronic Kidney Disease (CKD) is increasing. Initially, it was believed that 15-20 out of every 100 people have some stage of CKD. Preliminary results are now available from an ongoing nationwide study for early detection of CKD conducted by the Indian Society of Nephrology leadership. This study was conducted in collaboration with 1,100 physicians across the country. So far, 50,000 persons have been screened across India, and of these, 59.1% had diabetes. The study reveals that 31.3% of the population screened had microalbuminuria, which is one of the earliest indicators of chronic kidney disease. This is significantly higher than the prevalence of CKD reported in earlier studies.
Data reveals that CKD is now emerging as the 5th leading cause of death worldwide. Unlike heart disease and cancer, its prevalence is increasing. Kidney disease is a silent killer, and unlike heart disease and cancer, the symptoms often appear very late. Our study from SGPGI Lucknow in 1999 was among the earliest to show that diabetes (which was then considered a rich man’s disease) was emerging as the most common cause of end-stage renal disease in our country. Subsequent data from the registry of the Indian Society of Nephrology has validated our findings that diabetes is now the leading cause of CKD. An alarming observation is that the majority of patients are coming to nephrologists in stage 4 and stage 5 CKD. Both CKD and diabetes are lifestyle diseases and are essentially preventable.
Recent studies have shown that a persistent and ongoing CKD knowledge gap exists, one that is demonstrable at all levels of healthcare: among primary care physicians, nurses, dialysis technicians, the public, as well as policymakers. This has been compounded by the unbridled proliferation of social media platforms like Facebook, YouTube, Instagram, and Twitter. The COVID-19 pandemic, resulting in lockdowns, has further accelerated the growth of social media. The commercial nature of these platforms often results in widespread proliferation of content that is not proven to be true by scientific
The WKD Joint Steering Committee calls for everyone worldwide to not only be aware of the disease but to actively know what their own kidney health measures are. For example, individuals should be aware of their blood pressure, target levels, and treatment objectives. This is a cause that involves all of us in the kidney community worldwide — doctors (both nephrologists and primary care physicians), scientists, nurses, other healthcare providers, patients, administrators, health-policy experts, government officials, nephrology organizations, and foundations. Everyone needs to understand how a greater focus on kidney health in government policies can lead to major benefits for both patients and healthcare budgets.
Community screening for microalbuminuria needs to be done as part of the National Kidney Screening Programme. Our community survey has shown that this is a very simple and easy test, which can be done using a simple urine dipstick as a point-of-care (POC) test. It needs to be done using the first morning urine specimen. If the initial test is positive, it should be repeated for confirmation in a laboratory, along with serum creatinine value and an estimated GFR (eGFR). The importance of detecting microalbumin in urine is that it is the earliest indicator of kidney damage and often precedes the increase in urea and creatinine, which were once considered the gold standard for diagnosing CKD. Microalbuminuria is also a marker for heart diseases, and hence, it can help identify patients who need to be screened for cardiovascular diseases.
Additionally, we now have a plethora of new drugs that can help reduce microalbuminuria. Previously, the only available drugs were Angiotensin-Converting Enzyme Inhibitors (ACEI) like ramipril or Angiotensin Receptor Blockers (ARBs). However, over the last few years, fourth-generation calcium channel blockers (cilnidipine, benidipine, and azelnidipine) have become available, which help in blood pressure control as well as reduce microalbumin leakage in urine. In addition, SGLT2 inhibitors (Flozins) such as dapagliflozin, empagliflozin, and canagliflozin have been revolutionary in the treatment of diabetes, leading to dramatic reductions in CKD as well as cardiovascular disease. Most recently, Finerenone, a selective mineralocorticoid receptor blocker, has been approved for reducing microalbuminuria in diabetic kidney disease.
All these new drugs are now easily available in India and are much cheaper than the cost of treating CKD patients with dialysis or kidney transplants. Several research studies have shown that these medications not only add years to life but also improve the quality of life for CKD patients. Thus, a coordinated effort is needed at all levels of society to address the growing epidemic of kidney disease. Bridging the knowledge gap is key to achieving this because “Knowledge is Power.”
Healthy lifestyle choices can help improve overall health and significantly lower the risk of developing diabetes, kidney disease, and heart disease. Thus, it is a case of buy one, get two free in terms of preventive healthcare benefits.
Dr. Sanjeev Gulati, Immediate President, Indian Society of Nephrology, Executive Director, Nephrology and Kidney Transplant, Fortis Escorts, Okhla Road, New Delhi.