About 7,400 patients are on the waitlist for kidney transplants in Tamil Nadu, a number that remains high given the rising incidence of Chronic Kidney Diseases (CKD) primarily driven by diabetes and hypertension. This huge waitlist is a cause of concern for nephrologists for a number of reasons including the gap between the need and availability of organs, and it is for these reasons that they are reiterating the need to prevent kidney diseases as well as slow down the progress to complications.
According to the Transplant Authority of Tamil Nadu (TRANSTAN), a total of 7,413 persons are on the active waitlist (as of July 17) for kidneys.
Nithyashree Nandagopal, consultant nephrologist and transplant physician, Apollo Hospitals, Chennai noted that Tamil Nadu was a in the cadaveric transplant programme. “Yes, there is a growing number of patients on the waitlist for kidney transplants. This is because of an overall increase in the incidence of CKD due to comorbidities such as diabetes, hypertension and heart diseases, and lifestyle changes. In addition, we are also picking up many more cases than we used to. So while there is an increase in the factors leading to CKD, screening too has improved,” she said.
However, the availability of organs remains the same, Dr. Nandagopal noted, adding: “In fact, compared to a couple of decades ago, the availability of organs has reduced due to stringent traffic rules and regulations that have helped in reducing fatal accidents.” A large number of deceased donor organs come from road traffic accident victims.
Widening gap
N. Gopalakrishnan, senior nephrologist and member secretary, TRANSTAN, said the widening gap between demand and supply was a concern. “So, it boils down to prevention and there is an urgent need to act to prevent kidney failures. Transplant services should be further strengthened and expanded. No organ should be wasted. We should ensure maximum utilisation of donated organs. Even then, it is not going to be sufficient. Hence, prevention is key. CKD is a global crisis and is increasing exponentially due to lifestyle disorders such as diabetes, hypertension, obesity and environmental pollution,” he said.
Santosh Varughese, professor and head, Unit II, department of nephrology, Christian Medical College, Vellore, said that roughly 10% of the population may have some form of CKD. One per cent of the population may have advanced CKD requiring dialysis and/or kidney transplant.
Delays in seeking treatment
One of the causes for concern is delay in seeking treatment. “In a study done by us in 2004, we found that over half of patients were in CKD stage 5 at initial presentation. Patients coming late is one of the major problems,” Dr. Varughese said. “We tell our patients that it may take a minimum of two years on the waitlist and ask them to be prepared for that waiting time. The number of organs available is never going to match the requirement.”
With more people on the waitlist, one of the concerns as well as a challenge for doctors is to keep patients healthy on dialysis, Dr. Nithyashree observed. “This is because dialysis has its own problems. We need to keep patients healthy to be able to receive an organ.”
“For patients, it is important to adhere to dietary restrictions and be regular on the dialysis schedule. They have to take very little salt and little water. They may have to drink less than a litre of water, some may even need to restrict it to less than 750 ml. In a city like Chennai that has hot days, people tend to consume more water. In such instances, there will be no excretion — the accumulated water will need to be removed. So patients should follow dietary restrictions including salt and water, and should not skip dialysis schedules. They should do regular check-ups and undergo an annual cardiac screening,” she elaborated.
Though haemodialysis is free of cost in the government sector, mandays are lost for patients and their attendants when availing of dialysis, which results in a loss of income. Patients also have out-of-pocket expenditure for conveyance and food, Dr. Gopalakrishnan said.
The path ahead
Dr. Nithyashree lists out the dos and don’ts. A nutritious diet packing macro and micro nutrients in the right proportion along with physical activity is important to prevent kidney diseases. No smoking, no alcohol, avoiding fast food that is high in salt and added chemicals for preservatives, regulated water intake and avoiding over-the-counter medications are all crucial to preventing kidney diseases.
“What we can prevent is diabetes and hypertension-related kidney diseases,” Dr. Varughese, said, adding: “There is an exponential rise in the incidence of diabetes and hypertension, which are the most important risk factors for CKD. Longevity is another factor. With better medical care, people live longer, and that is another factor to take into consideration for increased prevalence of CKD and medical complications, similar to the West. As a society, we need to educate people to go for periodic health screenings. With such a huge CKD burden, it is imperative that all medical personnel be involved in care of patients with CKD. It is here that family physicians/primary care physicians play a crucial role in prevention and management. Primary care physicians can prevent or slow down the progression of chronic kidney disease and are important both for timely referral to nephrologists and for follow-up. They are an important part of the patient care team.”
Starting early is crucial as Dr. Gopalakrishnan stated. “The focus should be on having a healthy lifestyle from early childhood following a healthy diet, walking and exercise, and preventing overweight issues. There should be more potassium and less sodium in the diet from early childhood,” he said, emphasising the need for screening for diabetes and hypertension.
Those working outdoors should minimise the number of hours exposed to the environment, he added. The State, on its part, has rolled out a number of measures for prevention and control of diabetes and hypertension. “Tamil Nadu has initiated measures to screen people for diabetes and hypertension and deliver drugs to their doorsteps to ensure that controls are achieved,” he said.
