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Kidney disease is one of the most common non communicable diseases which are prevalent in many countries including India. Not much of data is available on the actual number of patients who are suffering from kidney ailments, due to unavailability of any nationwide council to record and track, but based on few surveys done, it is expected that around 1% of total Indian population are suffering from one or the other kind of kidney related ailment of which around 0.50% would be those suffering from chronic disease. On an average it is said that a person on dialysis gets it done twice or thrice. The dialysis cost in India, total expenditure is around 4k-5 thousand per session so it will be around 12000/ month and 1.44 lakhs/ annum. This though one tenth the cost of what we have in many developed countries like US & UK but still many are unable to afford this also. The average cost of a renal transplant is somewhere in between 5lacs to 6Lacs in India with 10 days stay in the private hospital. A government hospital does it for around 3 to 4lacs. Not many fully government run programs are there in our country to support patients suffering from chronic kidney disease. There is approximately 1000+ nephrologist in India and with more and more new hospitals are coming up with Nephrology centre of excellence. Major contributor for kidney problems are diabetics, hypertension, contributing to around 50% of the kidney related patients.

The best way to reduce the growth of number of patients suffering from kidney related problems is to start diagnosing at early stage, having a nationwide program to support and track these initiatives

With increasing lifestyle diseases like diabetics and hypertension and other cardiovascular diseases, it is believed that thousands of people every year need dialysis. With more than 1% of population affected with renal diseases, this number is only expected to rise in the coming years.

Renal Treatment and cost in India

As mentioned that high population and hence the number of people suffering from renal diseases is one of the major problems which India is facing now. Another big challenge which lies ahead is about the dialysis cost in India. Indian central or state government expenditure on health has just taken the focus, which have been neglected since many decades now. Usually the cost of haemodialysis is around Rs.5000 for one session. The cost of renal transplant though is around Rs.5, 00,000 if done in private hospital and around Rs.3, 00,000 if done in any government hospital. So if we see in a long term it is always advisable to get the renal transplant done, which increase the life expectancy of the patient as well it is also economical if taken the repeated cost of dialysis. Government has though launched many initiatives which have capped the drugs and consumables being used for the dialysis which has substantially reduced the prices and with many of the government run schemes like CM schemes and central schemes like CGHS and patient can take a treatment in any of the private hospital at subsidised prices. With advancement and more research done in this department, many newer drugs are introduced which are have good response till now, with only caveat that these are mostly going be innovator drugs which may increase the total cost and burden on the patients.

Many patients who are unable to afford treatment and also who do not have any government health benefit plan usually take help from their current employer for getting the treatment done, it is estimated that around 60% of such people are those who have taken help from their employer for getting a surgery done or have taken help from any type of charitable institution, another 25% of the people were those who have taken some type of loan for getting it done, the rest 30% were those who have sold their assets to get the surgery done. Despite all these, less than 7% of people are those who are able to get any kind of treatment. The risk is very high as not only the cost of treatment is very high, but also there is a collateral loss like loss of income due to away from work until the patient gets fully recovered. Together the burden is so high many patients intentionally despite getting detected do not get the treatment done.

Indian Healthcare Infrastructure

The next major challenge after cost of treatment is the availability of renal replacement. With limited number of dialysis units and centres available and lack of medical and paramedic staff, this is yet another problem which India is facing currently. Cadaver programs are still not that much a big hit and every year’s millions of organs are wasted due to unawareness, lac of education.

Only 5000 Renal Transplant is done annually only due to above mentioned issues and also majority of the transplant are living donor, the major reason is due to unavailability of Cadaveric programs across the country. Also Hospitals charge more cost for cadaveric transplants and hence it is slowly becoming a dying option. More and more private and government hospitals should promote donations of organs. Government of India has passed an organ transplant bill in 1994 still many things are yet to implemented on the ground. Only 20% of the total transplants done are cadaveric, we need to increase the awareness of organ donation to help reduce the mortality rate due to unavailability of organ.

This with all these infrastructural problems at hand and wide corruption at some of the levels it is very evident that healthcare system is not capable to provide treatment for all these ailing patients and hence the next course of action has to be thought off. (A large part of this article was inspired from the white paper written by S.K Agarwal – Department of Nephrology)

Steps & Next Course of Action

The only logical way looks like is, government should strive and focus all its efforts towards how to restrict the cause of renal diseases and take concrete steps towards preventing this disease. Like it is been found that people in the age group of 30-40 are in the highest risk of having kidney related problems and hence more preventive steps should be taken specially targeting towards these age group. The next should be patient having co morbidities or existing diseases like BP, Diabetic, and people working in more stressful jobs should be made aware periodically. Employer’s private and government should promote their employees in getting diagnostics tests done to detect these problems at an early stage so it can be treated with medicines.