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Resource centre on India's rural distress
 
 

Sharp rise in premature kidney deaths -GS Mudur
-The Telegraph

New Delhi: Premature deaths from kidney failure rose in India by about 38 per cent over the past decade, doctors said in a research study released on Tuesday that attributes this trend primarily to untreated or poorly managed diabetes.

The study, based on an analysis of deaths in over a million households across the country, has found that kidney failure increased to 2.9 per cent of the tracked deaths between 2011 and 2013 from 2.1 per cent exactly a decade earlier.

The findings, when extrapolated, would mean about 136,000 people between 15 and 69 years died from kidney failure in India in 2015, the researchers at the Postgraduate Institute of Medical Education and Research, Chandigarh, and the University of Toronto, Canada, said.

Although kidney failure is a long-term complication of diabetes, the researchers say the observed patterns of relatively early renal failure among patients with diabetes were unexpected.

"We were surprised by the high rates of renal failure deaths in adults with diabetes still in their 40s and 50s," Prabhat Jha, director of the Centre for Global Health Research at the University of Toronto who led the study, told The Telegraph.

"This suggests diabetes in Indian adults is mostly undiagnosed or under-treated, resulting in an acceleration of the renal failure complications," he added.

The study's findings were published on Tuesday in the journal Lancet.

Jha and his colleagues have for over a decade been analysing the cause of deaths in India through their so-called "million-death study" in collaboration with the registrar general of India. Since 2001, the study has monitored annual deaths in over 1.3 million households across the country.

The cause of death is assigned by specially-trained doctors based on information extracted from the households by surveyors who question family members about the presence and absence of key symptoms.

The study also found significant geographic variations in the rates of kidney failure deaths, not observed previously. The eastern states of Assam, Bengal, Jharkhand and Odisha had high death rates and experienced the greatest increase over the 10-year period, but Tamil Nadu, among all states, had the highest rate of renal failure, about 65 deaths per 100,000 population, compared to the national average of about 40.

"The geographic variations throw up questions for future research - we don't really know why some eastern states have higher rates of renal failure," said Vivekanand Jha, a senior nephrologist and executive director of The George Institute for Global Health, New Delhi, who was not associated with the study.

"Are there factors other than poor control of diabetes contributing to these trends? We need to find out," he said.

The researchers say their findings highlight the need for India to urgently implement strategies to prevent, detect early, and adequately treat diabetes and high blood pressure, another risk factor for kidney damage.

"Renal failure has been a silent epidemic in many high-income countries," Prabhat Jha said. "Without urgent action to address the risk factors of diabetes and high blood pressure, kidney failure is poised to become a major health and economic burden in India too."

The analysis also highlights the plight of patients with renal failure against a backdrop of poor treatment infrastructure. Patients with renal failure require dialysis, but a geospatial analysis cited by Prabhat Jha and his colleagues suggests that nearly 60 per cent of Indians live more than 50km away from a health facility providing dialysis.

Patients with renal failure typically require dialysis three to five times a week, and such long distances from a health care facility with dialysis services make regular treatment inaccessible.

Senior doctors say poor diabetes control in India may emerge from multiple factors - from the spiralling numbers of patients to poor patient compliance and inadequate access to proper treatment services.

"In our metros, the incidence of diabetes has gone up 10-fold from 2 per cent in the 1970s to about 20 per cent now," said Ambrish Mithal, head of endocrinology at Medanta, a private hospital in Gurgaon. "It is a chronic condition and not all patients find it easy to comply with instructions on medications and lifestyle."