Sunday, May 4, 2008

Kidney disease: the silent new epidemic of India

The first image is of the lower back showing the positions of the two kidneys. I got this image from here. And why is Swami Ramdev's image here? Please read on to find out why?!

Consider two very recent conversations that I had ...

A worried colleague shared her concern with me. Her brother-in-law, a diabetic, was found to have kidney failure, and was undergoing dialysis every alternate day. The cost of dialysis was Rs. 4000 (per dialysis). It was no doubt a financial burden to her sister's family along with the emotional agony.

Similarly, a long time field colleague of mine (who is now a first-line field manager in a top Pharma company) shared his anxiety: his aged father a long time insulin dependent diabetic was now undergoing dialysis thrice every week due to failing kidneys.

It is sad but true - India the country with the largest no. of diabetics in the world is on the throes of a yet another silent epidemic - kidney disease. It is not sensationalizing an issue. But open your eyes and ears to the incidence of kidney disease in your social circles, the incidence will shock you.

It is a costly disease

The burden of chronic kidney disease or kidney failure is far too much for the average person to bear. Each dialysis costs about Rs. 4000. Moreover there is a shortage of dialysis machines. It is said that there are just 3000 dialysis machines in India. Another colleague of mine shared his experience in Kerala. At a particular centre, where his sister was treated, he was shocked to notice the long line of people waiting for their turn for dialysis. The situation is getting very grave.

Kidney disease is insidious

The main hazard of kidney disease is that it is a silent killer disease. Almost symptomless. The disease overwhelms the person and announces its arrival only at the last stage.

I asked my first-line manager friend how this deadly disease was diagnosed in his father's case (a chronic insulin dependent diabetic)? He replied: 'Sunil, as such the main complaints were pain in the calf muscles, with spasms, itching, weight gain and a bulky or puffy profile and back pain. There were no 'initial symptoms'. It was, hence, difficult to diagnose at the early stage. The doctor too said that kidney disease does not cause any clear cut initial symptoms. So diagnosis is mostly at the advanced stage and are dialysis cases. It is a very scary picture, Sunil, the doctor said that there is worrying trend of increasing kidney disease cases. He suspects, hyperglycemia and pollutants as causing this problem'.

What my first-line field manager friend added was even more worrying ... "dialysis is a sort of palliative or supportive measure. Although it helps reduce morbidity there is no significant prolongation of life in such patients. It is in fact a sort of business now here in Bangalore. You have got to shell all that cash', he added with frustration, 'yet you know it is not something that can go on like this...'. I could understand my friend's depression.

The only option is education and early detection

The importance of early detection is highlighted here in this link. The most important facts to educate on are:

Kidney disease occurs mainly due to:

a) diabetes (which will hit 57.2 million Indians by 2025 AD) ie. diabetes nephropathy (the obvious leading cause of end stage renal disease in India)
b) hypertension (high blood pressure)
c) iatrogenic kidney disease (or kidney disease as a side effect of drugs like chronic use of pain killers eg., by arthritics); and kidney disease due to inflammation and infection.

The importance of education and early detection is a prime opportunity for social marketing initiatives for marketing antidiabetic and antihypertensive drugs. Direct-to-patient campaigns and patient education campaigns through the prescriber or pharmacist or any other healthcare professional like the nurse, will not only serve to educate the target audience, it will also help in brand building.

The other aspects to educate on: proteinuria (presence of protein in urine, which indicates diabetic nephropathy) and regular urine creatinine level measurement.

Chronic disease caused about 54% of deaths in India in 2005. The fact is that the Pharma market for chronic diseases is booming in India. No wonder that Mixtard a brand of human insulin is one of the top three brands in India. Biocon a company focused on lifestyle and chronic disorder segment is experiencing more that 50% growth. Atorvastatin and ramipril are among the top selling drugs in India and are growing at very high rates. Cardiovascular disease, diabetes, cancer, and chronic respiratory disease are the main chronic diseases... BUT HIDDEN IS THE SILENT EPIDEMIC of CHRONIC KIDNEY DISEASE. READ MORE BY CLICKING HERE.

A focus on prediabetes and prehypertension is required

The words prediabetes (or impaired glucose tolerance) and prehypertension are yet to enter the common man's lexicon. High bp and High blood sugar have already entered the common man's vocabulary. The need to highlight on prediabetes and prehypertension is very important. We have a publicity savvy (and controversy kicking: Dr. Venugopal controversy of AIIMS, smoking and alcohol consumption controversy) Union Minister for Health Dr. Anbumani Ramdoss, perhaps he can pick up this as a theme campaign. While social marketing campaigns of Pharma companies can focus on prediabetes and prehypertension, to bolster their antidiabetic and antihypertensive brands, perhaps big stake holder Pharma companies of the diabetes and hypertension markets can come together, create a common fund, hire a good advertisement agency, and unleash a market building and national awareness campaign on prediabetes and prehypertension. It makes good economic and social service sense.

Liver and kidney disease

As was highlighted by the earlier blogpost, the liver is a strategic organ. Liver is an important organ of detoxification. The load of toxins in the blood is increased by liver stress. So logic dictates that incidence and severity of kidney disease increases in patients with hepatic dysfunctioning or fatty liver or cirrhosis of liver. Hence, it is observed clinically that alcoholics particularly diabetics who consume significant alcohol suffer from kidney disease to a greater extent.

Angiopathy (vasculopathy) and kidney disease

Angiopathy refers to disease of the blood vessels. The first stage is endothelial dysfunction - the integrity and functioning of the first innermost layer of the blood vessel is affected. Endothelial dysfunctioning leads to atherosclerosis (hardening of the blood vessel walls and consequent loss of elasticity). Angiopathy causes impaired blood flow to an organ. Imagine angiopathy in the blood vessels of the kidney and the one connecting to the kidney (ie., renal artery). Renal angiopathy has disastrous consequences on kidney functioning.

Now, one of the complications of diabetes is angiopathy. So add the grave situations together ... angiopathy, liver stress, hypertension, and diabetes. The dangers are very formidable. It is a challenge before our nation.

The problem with insidious diseases

The major problem with insidious diseases like osteoporosis, kidney disease, and angiopathy, is Oh! I do not think it will happen to me. And once it happens the cycle of denial, depression, and acceptance. Insidious diseases come unannounced and curse the sufferer. Beware.

In Yoga we trust

Swami Ramdev (who regularly features in Aastha channel at 5.00 am) is revolutionizing healthcare through pranayama and Yoga. And it works. It is said to work for kidney disease and diabetes too. No harm trying it. PLEASE CLICK HERE. That is why I have put a image of Swami Ramdev at the top of this blogpost obtained from here.

In Ayurveda, punarnava and gokshura are said to support kidney function. And even help revive kidney functions.

Thanks for reading this blogpost, please do read all others by scrolling down and clicking on older posts wherever required.

No comments: