Cases of kidney failure have increased exponentially in India over the last few years due to various factors, including unhealthy lifestyle. But the treatment, which involves dialysis and transplant, is still costly and complex. This is despite the fact that the quality of treatment in the country is at par with the global standards and the government is sharing the disease burden to some extent.
This and many other issues related to kidney care were discussed at length at the Health Conclave—themed “Kidney for Life”—organised by NewsX and The Sunday Guardian earlier this week at Delhi’s India International Centre (IIC). The conference was attended by senior nephrologists, urologists, transplant experts, NGO reps, members of prominent kidney forums, policymakers and corporate executives.
The purpose of the meeting was to provide an idea exchange forum on the best kidney care and treatment practices from within India and around the world, and to discuss multi-sectoral policies to create an enabling environment for reducing the burden of non-communicable diseases (NCDs) on our society. The participants also discussed a number of crucial policy matters pertaining to the health sector, with focus on kidney care.
NCDs are currently the leading cause of preventable death and disability worldwide, especially in the South-East Asia region. As the origins of NCDs lie outside the health arena, tackling them requires multi-level co-operation cutting across several sectors.
The conference also had an open Q&A session between senior nephrologists and audience members, many of whom were CKD (chronic kidney disease) patients, transplant recipients and donors. The forum provided a unique opportunity to connect one-to-one with the who’s who of nephrology and urology, as well as with senior policymakers.
Giving a broad outline, Dr Dinesh Khullar, chairman and head of department, Nephrology and Kidney Transplant, Max Hospital Saket, said that in a country of 1.3 billion, there are only 1,850 nephrologists, and most of them are concentrated in urban areas. There are only 4,950 dialysis centres in the country—the existing demand for such centres is hardly met with this infrastructure in place.
He further said that quality dialysis can ensure long term survival. “Now people with kidney diseases are surviving for 15 to 20 years in India. It could be even more in the days to come if the quality of dialysis is improved and a good transplant system is in place. In that case, such patients can survive even more than 30 years, as has been the case in other countries like Japan,” he added while giving his presentation on “Dialysis in India: Few Myths and Realities”.
The speakers at the conference were of the view that though there are three options for kidney treatment —transplant, hemodialysis and peritoneal dialysis—transplant is the best, but there is an acute shortage of available kidneys at organ banks. Hemodialysis, though a good option, is still costly, despite the fact that its cost has come down considerably compared to few years ago. Peritoneal dialysis (PD), which is easier and can be done at home, is yet to become popular, the major reason being that insurance companies don’t reimburse the cost of this mode of treatment, as this does not require hospitalisation. Also, patients do not want take the burden of PD procedures at home, for fear of infection and other complexities involved.
Though there is a central body called the National Organ and Tissue Transplant Organisation (NOTTO), with its unit at state and regional levels (SOTTO and ROTTO), the system of organ transplant has not been streamlined so far. There was a consensus at the conclave that the waiting list of kidney recipients has to be objective and transparent, so that they get kidneys on time, without any hassles.
The list of kidney donors and recipients, too, has to be updated regularly, with hospitals providing information to NOTTO, SOTTO and ROTTO on a regular basis. There should be a “national waiting list” for the convenience of those who need a kidney transplant. Though the intent of the government is good, there are issues with the implementation of policies, the speakers felt.
The speakers lamented that the donors’ pool is small while the demand is very high. “There is a huge gap between demand and supply. This can be bridged by increasing the number of donors. For this, there is a need to sensitise people about organ donation,” the speakers said. The Indian Medical Association (IMA), the audience was informed, is working on creating awareness about organ donation. Also, experts here said that insurance companies should be asked to also cover the cost of peritoneal dialysis.
Dr D.S. Rana, Chairman, Department of Nephrology, Sir Ganga Ram Hospital, spoke on the topic of “Evolution in Nephrology: 1950 and Beyond”. He spoke about kidney cure, precautions and transplants and said that painkillers should be consumed rarely as they may cause kidney failure. He said, “With better understanding of the pathophysiology, we are able to carry primary and secondary prevention of most of the causative diseases leading to kidney diseases.Even if chronic kidney failure sets in, it is possible to prolong the journey to end-stage kidney failure. Better facilities like dialysis and transplantation are available to prolong the life of end-stage kidney failure patients… The crowning achievement has been the transformation of fatal end-stage kidney disease into a treatable illness—one of the greatest therapeutic achievements in the history of medicine.”
Dr Vijay Kher, Chairman, Nephrology, Medanta the Medicity, spoke on the topic “Recent Trends in Kidney Transplantation”. He said: “Transplantation is the cheapest and best way to treat kidney failure.” He also mentioned that diabetes is the leading cause of kidney failure worldwide.
At a special session on “Pre and Post Transplant Care: Lifestyle Changes, Fooding Habits: Emphasis on Role of Medicine and Diagnostics”, the panelists, including Dr Dushyant Nadar, Dr Garima Aggarwal, transplant coordinators Neha Bali and Prachi Gupta, talked about kidney functioning and transplant, organ donation processes, how safe is organ donation, and how people can lead a normal life after receiving a new kidney.
Stressing on “prevention is cure”, the panelists said that people should keep a check on diabetes, hypertension and get regular KFT (Kidney Function Test) conducted. People should avoid smoking, alcohol and adopt a healthy lifestyle. One should also avoid the practice of using over-the-counter medicines, without doctor’s advice, as many of them are harmful for the kidney, the panelists said.
Dr Sanjeev Bagai, pediatric nephrologist, spoke about the genesis of CKD in the womb and the role of technology in early diagnosis of renal disorders in newborns. Dr Harsha Jauhari, Chairman, Renal Transplant Centre, Sir Ganga Ram Hospital, Pallavi Kumar, Executive Director, Mohan Foundation and Dr Anil Goyal talked about “Organ Donation: Sharing of Organs, Medico-legal Cases, Brain Death Certification and Maintenance, Wastage of Organs, Organ Swapping”. During the session, the panelists discussed the legal consequences and other nitty-gritty of organ donation.
There was a closed room session on policy matters related to transplant and organ donation—on the roadblocks and reforms—which was attended by Dr Vijay Kher, Chairman, Nephrology & Urology, Medanta the Medicity; Dr Sanjeev Bagai, Chairman & Managing Director, Nephron Clinic, Specialist in Paediatric Nephrology; Dr Dinesh Khullar, Head of Nephrology, Max Saket; Dr Yasir S. Rizwi, Senior Consultant, Nephrology, Dharamshila Narayana; Dr Pranaw K. Jha, Senior Consultant, Nephrology & Urology, Medanta the Medicity; Dr Reetesh Sharma, Director and Head Nephrology and Kidney Transplant Medicine, AIMS; and Pallavi Kumar, Executive Director, Mohan Foundation. The government panel was represented by Dr S. Rajesh, Director Health, NITI Aayog; Dr Promila Gupta, Principal Consultant, DGHS; Dr Megha Pravin Khobragade, Joint Director (NOTTO); Dr Aarti Vij, Professor of Hospital administration and faculty head ORBO, AIIMS.