Recent studies have indicated that even the earliest stages of chronic kidney disease (CKD) can have significant impacts on quality of life.
Across India, the burden of kidney disease lacks precise definition and is often neglected in favour of persistent challenges posed by communicable diseases or more high-profile noncommunicable diseases such as heart disease cancer. However, kidney disease is believed to affect one in every ten Indians and almost five lakh Indians are believed to be in need of treatment with dialysis. Overall, kidney disease is believed to be the eighth leading cause of death in the country.
The study included assessments of mental health, physical health, burden of kidney disease, symptoms and problems of kidney disease, and effects of kidney disease. “We found that between fifteen and 22 out of every 100 Indian patients with mild-to-moderate CKD had significant impairment in at least one of the five domains of quality of life,” said project leader Vivekanand Jha, MD, George Institute for Global Health. This dispels the common notion that only those who are at the stage where dialysis or transplant becomes a necessity have a notable impact on their daily life.
The study found that there are distinct groups deemed to be more at risk from quality of life decline. After adjusting for other factors that may impact quality of life, lower quality of life scores were associated with lower income, poor education, and female gender. “The findings point to the need to prioritise interventions targeted to these populations. Better understanding of the nature of these associations, and how they evolve over time—which will be ascertained in the follow-up phase of the study—will allow development of tailored interventions.” said Jha.
Identification of groups that are more prone to quality of life degradation allows for targeted efforts on the part of the healthcare system to improve situations and address issues. One of the key factors impacting quality of life is economic background, with those from impoverished backgrounds reporting greater impact on quality of life. This would indicate that the group likely struggles to avail treatment due to associated costs.
A key issue will be improving access to transplants, a matter that can only really be resolved through increased donations. At present, kidney donations are scarce in India. This means that many who suffer from CKD are left with dialysis as their only option. For many, this is a costly endeavour — if it is an accessible option at all — not simply due to the cost of the procedure, but due to the need to travel to a facility equipped to carry out the procedure also driving up costs.
Figures show that around 1.6 lakh patients are waiting for organs in the nation with a mere 12,000 donors available. This has created a situation conducive for a black market to operate — with those in impoverished communities being taken advantage of. Those who are desperate for life saving operations are willing to pay vastly inflated prices to save their lives. The contrast is also the case, with those living in abject poverty willing to donate their kidneys in exchange for a mere fraction of the final selling price simply in order to buy food.
Previous campaigns have been enacted to increase the number of kidney donations, such as “poochna mat bhoolo” or “don’t forget to ask” held in 2017, which targeted three lakh (300,000) doctors to attempt to encourage families to donate the organs of loved ones who lost their lives. However, the outcome has not increased the number of organ donations to any significant degree, indicating that India’s largely unresolved issue of CKD is likely to continue to cause issues well into the future – and continued suffering for those affected by the condition.