Chronic Kidney Disease in India: Two important markers to detect kidney disease | Health

The kidneys play a vital role in acting as filters by removing waste and extra fluids from the body and by keeping blood pressure under control but as per reports, it is estimated that one in eight Indians experience chronic kidney disease – a health condition where one’s kidney function is impaired gradually. Rising cases of chronic kidney disease take a toll not only on patients but also on the healthcare system hence, there is a clear need to address this challenge by promoting CKD screening, so it can be identified at an early stage enabling earlier treatment and management, which may slow or regress the progression of the condition.

In India, CKD is an especially pressing problem as it is commonly observed in people with diabetes – with studies suggesting almost one in two people with diabetes, suffering with CKD. We have a large population of people in India living with diabetes at an estimated 77 million adults and according to health experts, this forms a risk factor, along with hypertension, heart diseases, obesity, family history of CKD, older age, smoking and more thus, it becomes important for people across the country – particularly those at high-risk – to get screened for the disease.

In an interview with HT Lifestyle, Dr Ambrish Mithal, Chairman, Endocrinology and Diabetes at Max Super Specialty Hospital in Saket and Max Hospital in Gurgaon, revealed, “Unfortunately, CKD is underdiagnosed. Clinicians were found to be more successful in recognizing the disease in its advanced stages – but even then, nearly half of the patients in a late stage of the disease were missed, according to a study. Broadly, kidney function testing coverage is low. This is for a number of reasons, with a prominent one being a lack of understanding and knowledge of CKD, amongst those affected, and at times, even amongst primary care healthcare practitioners. Typically results for tests such as urine albumin or creatinine or eGFR take time to come, and this may cause an impediment for patients, particularly those who are travelling for care. These particularly pose a problem for people in rural areas affected by the condition. It is important to bridge such gaps using newer technologies.”

Sharing that early detection of CKD supported by screening remains an important economically viable option to reduce the strain of kidney failure on healthcare infrastructure, he suggested, “Widescale testing is vital as early CKD can be asymptomatic. In at-risk individuals, early detection can also help people better manage their health. International guidelines recommend screening at least annually for kidney dysfunction in patients with diabetes.”

According to him, two important markers to detect kidney disease are urine Albumin-Creatinine Ratio (uACR) and estimated Glomerular Filtration Rate (eGFR). Dr Ambrish Mithal said, “In India, testing varies in different clinics and hospitals, and there can be challenges with the uptake of testing, including economic factors and the rural-urban divide. Studies suggest >50% of CKD patients get diagnosed very late in India leading to higher treatment & management costs for the patients.vi It is clear that the country can benefit from more accessible tests, such as point-of-care tests, which prove a useful option. Point-of-care fully quantitative uACR test may take around 5 minutes to show result and can be an option in the physician’s clinic to screen patients with risk factors such as diabetes or hypertension.”

While the adoption of these is at a nascent stage in India, its advantages are clear. Dr Ambrish Mithal gushed, “It can minimise the burden on patients and healthcare delivery centres and support detection and sustained medical care more smoothly. Such tests can offer reliable results conveniently and swiftly that too near patient or in physician’s office, which can be used as a screening tool for risk stratification and early-stage screening as well. These tests, done regularly, can also support doctors in selecting and adjusting treatment as part of the patient’s long-term disease management, enabling a degree of personalisation. Beyond encouraging testing, there are also other important areas to address. One is helping build a clearer understanding of the disease through knowledge-sharing workshops or programs with general physicians, not just specialists. This can be started at earlier stages, such as during medical training at educational facilities. This is an important consideration given the gap between the number of specialist doctors and people with chronic kidney disease in the country. Raising awareness of the benefits of tests, such as for kidney function, amongst patients is also important, to support consistent and regular testing and adherence to treatment plans.”

By advancing information and scalable screening options, we can move towards reducing India’s burden of chronic kidney disease.