Prevention of chronic renal failure at the community level

Abstract

Renal transplantation in India costs about US$5000 ($1=Rupees 48.25), azathioprine costs $200 a year and cyclosporine costs $2000. Against this the average per capita income is $279 (Rs. 12989) per year; 36% of the population earn less than $105, and only 2.2% earn more than $1000. The country cannot afford to treat end-stage renal disease. Thirty percent of chronic renal failure is due to diabetic nephropathy, and 10% each to hypertensive nephropathy and chronic pyelonephritis. Social and preventive health workers of the Kidney Help Trust administered a questionnaire at the homes of a study population of 25,000, examined the urine of every individual for albumin and reducing substances, and checked the blood pressure of every person aged over 5; 90% of the population cooperated. Six percent were hypertensive and four percent had diabetes. Eight percent of them subsequently took regular treatment. Using only reserpine, hydrallazine and hydrochlorothiazide for hypertension, and glibenclamide and metformin for diabetes (as these are the cheapest agents available), we were able to control the blood pressure to 140/90 or less in 96% of cases, and to reduce HbAIC by 10% or more of the original reading in 77%. An HbA1C of 7% was achieved in 50% of the diabetic subjects. The total cost amounts to 27 US cents for one year per capita of the study population. The Indian Government now spends $7.67 per capita on health each year, but expects patients to attend its Primary Health Centers. The patients do not attend because in doing so they lose a day's wages. We believe that domiciliary treatment is the solution for these diseases, and expect to see a fall in the incidence of chronic renal failure if this is instituted in the future.

To study the clinical profile of chronic kidney disease and associated comorbidities in geriatric patients

“…Early stages of CKD can be detected through laboratory testing only. 4,5 The CKD is a known end result of type 2 diabetes mellitus and hypertension in recent times, it is associated with many features like hyperkalemia, hypocalcemia, hyponatremia, anaemia, hypoalbuminemia etc. So if we detect all these features early, we can extend the quality life of CKD patients by timely interventions.…”

“…So if we detect all these features early, we can extend the quality life of CKD patients by timely interventions. [4][5][6] The CKD is defined as kidney damage for 3 months, as shown by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest by either pathological abnormalities or by markers of kidney damage, including abnormalities in the composition of the blood , urine, or in imaging tests and also defined by GFR < 60 ml/min/1.73 m 2 for 3 months, with or without kidney damage. 7 The GFR is considered as the best measure of overall kidney function.…”

Clinical and epidemiological profile of chronic kidney disease patients in a tertiary care referral centre in South India

“…The cause of CKD is assigned based on presence or absence of underlying systemic diseases and location of known or presumed pathologic abnormalities (glomerular, tubule-interstitial, vascular or cystic and congenital diseases). 1 GFR category is assigned as G1 (>90ml/min/1.73m 2 ), G2 (60-89ml/min/1.73m…”

“…This puts a substantial burden on global health resources since all modalities of treatment are expensive. In a developing country like India only 3% to 5% of all patients with ESRD get some form of renal replacement therapy 2 . Hence planning for prevention of CKD based on screening and identification of the at-risk population is the only practical solution possible for India.…”

Conservative Management of Chronic Renal Failure

“…India is estimated at 7572 per million and end stage kidney disease at 757 per million population with a staggering financial and social burden [1]. To reduce this burden and improve patient outcome, CKD should be detected and treated before the onset of kidney failure through investigations and prompt treatment of CKD.…”