Uncontrolled diabetes and hypertension are the most common causes for kidney ailments

On World Kidney Day on March 12, nephrologists debated and spoke of various diseases related to the organ, but it was hypertension and diabetes that were constant refrains among them. Without exception, experts continued to stress that uncontrolled diabetes and hypertension were the most common causes for kidney ailments.

As evidenced by a three-year study by nephrologists at NIMS, Hyderabad, 32 per cent of End Stage Renal Disease (ESRD) patients had diabetes. The study was conducted on 237 kidney patients in Telangana, the results of which were published in the 2011 issue of Haemodialysis International . It said only 30 per cent patients were aware of the option of a kidney transplant.

“Having optimum levels of BP and sugar is a must to avoid kidney ailments. In our study, we found that 43 per cent of kidney patients drop out from treatment. The disease burden of kidney ailments is increasing because of present-day lifestyle,” says Swarna Latha, Associate Professor of nephrology at NIMS, and in-charge of the State-run Jeevandan programme.

Prevention the cure

Senior doctors say prevention is the only way to avoid kidney ailments. “Prevention is vital because treatment for kidney disease is very expensive and prohibitive. Close to 4.5 lakh patients develop kidney failure in India and most of them come to the physician in the late stages,” says president-elect of the Indian Society of Nephrology (ISN) Pradeep Deshpande

Silent entry

Doctors point out that in most cases, early kidney disease is asymptomatic with no visible signs or symptoms that a person might have a kidney disease. “Besides being silent, what is more worrying is that there is an explosion of kidney diseases in this century because of lifestyle diseases like diabetes, hypertension and obesity. It is important to understand that once kidney disease is established over three to six months, it is irreversible,” says the head of nephrology at Yashoda Hospitals Urmila Anandh.

Key to a healthy kidney

“Leading a healthy and balanced life with a sensible diet, appropriate fluid intake, adequate sleep, regular exercise, avoidance of unnecessary medications and good control of underlying diseases like BP and sugar are key for a health kidney,” says senior kidney specialist at Apollo Hospitals V. Ravi Andrews. Some experts have also come up with simple solutions. “Drink a glass of water and give one to others to protect kidneys. While water may not cure kidney ailments, but it definitely will protect kidneys,” says C. Mallkarjuna of Asian Institute of Nephrology and Urology.

Reporting by M. Sai Gopal

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TAGBILARAN CITY. – The proposed increase of the bed capacity of the regional hospital here has been approved by the House committee on health, Rep. Rene L Relampagos of Bohol’s first district issued the disclosure yesterday.
The first district solon said House Bill No. 3516 which seeks to increase the bed capacity of Gov. Celestino Gallares Memorial Hospital (GCGMH) here from 225 to 526 has been approved by the House committee during its meeting last Wednesday.
The present regional hospital here was initially called as the Bohol Provincial Hospital by virtue of Republic Act No. 3114 which opened on October 19, 1929. Pursuant to Administrative Order No. 38, series of 1980 by the Ministry of Health, Bohol Provincial Hospital was originally designed as a Regional Teaching and Training Hospital for Region VII. It was then an 8-bed capacity hospital.
In 1984, under Batas Pambansa Bilang 640, the hospital was renamed Governor Celestino Gallares Memorial Hospital (GCGMH). The bed capacity of GCGMH was increased to 150, then to 200 and finally to 225 beds under Republic Act No. 7266 which was enacted on March 20, 1992.
In his sponsorship speech, Rep. Relampagos said that this proposal is also fully supported by the Regional Development Council (RDC) of Region VII as well as the National Economic and Development Authority (NEDA). In fact, initial allocation had already been included in the 2015 General Appropriations Act (GAA) but additional allocation will be needed to complete the project.
Dr. Jaime Bernadas of the Department of Health (DOH) Region VII, who attended the meeting, also gave his full support to HB 3516.
Cong. Relampagos elaborated that for more than 20 years since the enactment of Republic Act 7266, the bed capacity of GCGMH has not changed despite the significant change in the number of patients being served by the hospital. Consequently, there is also a need to substantially improve the facilities and services of the hospital.
Also discussed in the said congressional meeting last Wednesday is the legislative proposal to increase dialysis allocation by patient of PhilHealth from the current 45 sessions to 90 sessions per year under House Bill No. 5403 and House Resolution No. 1516.
Dr. Dator, executive director of the National Kidney Transplant Institute (NKTI) said that institute fully supports the proposed expanded coverage of dialysis treatment.
However, NKTI gave a presentation as to the current situation of End Stage Renal Disease (ESRD) in the country. They said that new cases of ESRD increases by 18%-20% per year and the leading causes remain diabetes and hypertension. They further said the increase in subsidy for dialysis means higher survival for renal disease patients. More importantly, in their presentation, they distinguished between the more commonly known hemodialysis (HD) and peritoneal dialysis (PD) which NKTI promotes.
NKTI further said that they have adopted the “PD First Policy” and are willing to give trainings to medical as well as non-medical practitioners for PD. They said that with the current allocation of PhilHealth under the Z Benefit Package, patients can be fully supported if they opt for PD rather than HD.
Rep. Relampagos, seeing the potential of PD said that he will further study the matter and file an appropriate legislative proposal to support and push for a ‘PD First Policy’ by DOH for the entire country.
He pointed out that given our lack of funds, PD can well respond to the needs of renal patients as against the usually expensive HD. In the meantime, the first district manifested his intention to be a co-author of the legislative measures to increase dialysis allocations under PhilHealth. (with reports from Dandreb James L. Arro)

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KOTA KINABALU: The Health Department plans to set up complete dialysis services in all hospitals in the State to ensure delivery of these services is more inclusive to all kidney patients.

State Health Director Dr Christina Rundi said the department has been able to provide dialysis services in all hospitals in Sabah except in two areas – Kunak and Pitas.

"We hope this year we will be able to provide dialysis services in these two hospitals and with that, to make all hospitals in Sabah a place that can provide dialysis services," she said at the State's World Kidney Day celebration at the Queen Elizabeth Hospital, here, Saturday.

Dr Rundi stated that Kuala Penyu district recently received its new dialysis equipment and had started dialysis services early this year.

She added that the department is still working hard to ensure kidney patients can undergo dialysis treatment in their respective district hospital without having to move to another district to get treatment as there is still a shortage of dialysis machines in some places.

"These are the things that we plan to do for Sabah," she said, adding that people need to look after their kidneys in order not to get to the point where they have to wait for dialysis machines to be placed in their area. Dr Rundi said every year, the number of Malaysians suffering from kidney failure is increasing.

"In 2012, a total of 20,971 citizens of this country were undergoing dialysis treatment and this number increased to 31,637 in 2013, of which 6,222 were new dialysis patients.

"The number is expected to continue increasing if health care measures are not prioritised," she said.

She said in addition to dialysis, alternative treatment for patients suffering from kidney failure as well as that of other organs such as the heart, lungs and heart is through organ transplantation.

"Currently, an approximate 20,000 patients are waiting for organs, mainly kidney patients.

"Therefore, while waiting for a suitable organ, a patient who suffers from kidney failure, must undergo dialysis treatment," she said.

Dr Rundi said the objectives for this year's World Kidney Day celebration themed "Fresh Life for All" were to create public awareness about kidney care, highlighting issues relating to the treatment of diseases, educating the public about the importance of kidney care from an early stage and to detect undiagnosed patients through free health screenings.

She called on more parties including non-governmental organisations and the private sector to come forward to help the Government, especially the Ministry of Health in addressing the issue of kidney disease.

The event was jointly organised by the Nephrology Unit and Health Promotion Unit of the QEH. Health talks, health screening and exhibition were also conducted at the event. Also present were QEH director Dr Heric Coray, Nephrology Unit Head Dr Wong Koh Wei and Health Promotion Unit Head Norsaadah Omar.

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Kate S Wiles^12*, Kate Bramham¹², Alina Vais¹, Kate R Harding¹, Paramit Chowdhury¹, Cath J Taylor² and Catherine Nelson-Piercy¹³

• * Corresponding author: Kate S Wiles This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Author Affiliations

¹ Guy¿s and St Thomas¿ NHS Foundation Trust, London, UK

² King¿s College London, London, UK

³ Imperial College Healthcare NHS Trust, London, UK

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BMC Nephrology 2015, 16:28  doi:10.1186/s12882-015-0024-6

Abstract (provisional)

Background Women with chronic kidney disease have an increased risk of maternal and fetal complications in pregnancy. Pre-pregnancy counselling is recommended but the format of the counselling process and the experience of the patient have never been assessed. This study examines the experience of women with chronic kidney disease attending pre-pregnancy counselling and evaluates their pregnancy outcomes. Methods This is a cross-sectional assessment of 179 women with chronic kidney disease attending a pre-pregnancy counselling clinic (2003–2011) with retrospective evaluation of aetiology, comorbidity, treatment and adverse pregnancy outcome compared with 277 hospital controls. It includes an analysis of descriptive data and free text content from 72 questionnaire responders. Results 65/72 (90%) of women found the clinic informative. 66 women (92%) felt that the consultation had helped them decide about pursuing pregnancy. 12 women (17%) found the multidisciplinary process intimidating. Free text comments supported the positive nature of the counselling experience, but also highlighted issues of access and emotional impact. Adverse pregnancy outcome rates were significantly higher in women with chronic kidney disease: 7/35 (20%) had pre-eclampsia (p?<?0.001), 8/35 (23%) infants were small for gestational age (p?<?0.001), 11/35 (31%) had preterm deliveries (<37 weeks) (p?<?0.001) and 5/35 (14%) had a pregnancy loss compared with 4%, 10%, 8% and 3% of controls respectively. Conclusions Women with a diverse range of renal disease severity and complexity attend pre-pregnancy counselling. Factors affecting pregnancy include hypertension, proteinuria and teratogenic medication. It is important to be able to inform women of the risks to them and their babies before pregnancy in order to facilitate informed-decision making. Most women with chronic kidney disease attending a pre-pregnancy counselling clinic report a positive experience.

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