Kidney failure, dialysis and transplantation

Florine Roche
Daijiworld Media Network

Mangalore, Mar 14: World Kidney Day is celebrated on March 14 this year. The first World Kidney Day was observed in 2006 to create awareness among public regarding the importance of kidneys in the overall health and hence reduce kidney related ailments worldwide. Since then, the second Thursday of March is observed as the World Kidney Day (WKD) in more than 100 countries. The World Kidney Day aims to create awareness among people to maintain their kidney health so that they do not reach a point where they need dialysis or transplantation.
 
Common conditions like diabetes and high blood pressure can cause kidney damage. A lot of people may be unaware of this fact. India has emerged as the diabetic capital of the world and it also accounts for the highest incidences of hypertension in the world owing to many reasons including lifestyle changes. There is a close link between diabetes/hypertension and kidney failure and diabetes is the single most important cause for kidney failure. About 66% of kidney failures are said to be due to diabetes and hypertension, and in India about 25 to 40% of the population is said to be at risk to chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Hence, we should be aware of kidney diseases, their causes, symptoms, treatment and prevention. It is often considered that dialysis is the end of the road to a person, which is not true. Doctors say there are people who are able to lead a near normal life for years together, though it is quite a drain on their finances. While kidney transplantation is one of the two options (other being dialysis) for patients with end-stage renal diseases, there are many intricate aspects people should be aware of, so that they can effectively deal with the problem.

The print and electronic media has been flooded with requests from patients from time to time seeking financial help for renal transplantation as the cost involved in private hospitals for transplantation is beyond the reach of the poor. There are various government facilities available to the poor and needy for treatment. Not many are aware that free dialysis and transplantation facility is provided to the poor people through an institution aided by the Karnataka Government namely Institute of Nephro Urology in Bangalore.

This article, first published in daijiworld on November 5, 2012, has been republished on the occasion of World Kidney Day, to provide authentic information for people to deal with Kidney failure, focusing on the causes, prevention and treatment including Kidney transplantation and the facilities of low cost/free dialysis and transplantation available at the Karnataka government funded autonomous organization “Institute of Nephro Urology” in Bangalore. We provide excerpts of the interview with Consultant Urologist Dr Nischith D'Souza and Nephrologist Dr Jagadeesh T in Mangalore.

Dr T Jagadeesh

Dr T Jagadeesh is one of the leading Nephrologists of Mangalore. Dr Jagadeesh completed his MBBS from Bangalore Medical College and went on to do MD (Internal Medicine) in Bangalore Medical College. He went on to do his DNB in Internal Medicine from National Board Examinations, New Delhi and his DM (Nephrology) from Christian Medical College, Vellore. He also did his DNB (Nephrology) from National Board of Examinations New Delhi. Dr Jagadeesh has the distinction of being the first Nephrologist in the district to start dialysis programme in Mangalore and is credited for conduction the first renal transplant in the city of Mangalore.

Currently he is working as Chief Nephrologist in Yenepoya University Hospital, Deralakatte, Mangalore and Yenepoya Specialty Hospital Kodialbail, Mangalore. Dr Jagadeesh can be contacted on telephone number 0824-4238855 and on email jagadeesharuna@gmail.com.

Dr Nischith D’Souza

Dr Nischith D’Souza, who has done his Superspeciality training in MCh Urology atInstitute of NephroUrology, Bangalore, has had extensive training in Living related as well as Cadaveric Renal Transplantation at the above Institute as well as Chrisian Medical College, Vellore, Tamil Nadu. He has conducted research in dialysis access surgery, post transplant renal artery stenosis, as well as management and organ harvesting of brain dead cadaveric donors.

He is currently faculty in the Department of Urology and Renal Transplantation at Yenepoya University Hospital, Mangalore and can be also be contacted at ‘KIDNEY CLINIC’, Don Bosco Hall Cross Road, Falnir, Mangalore on telephone number 0824-2422166 and on E mail: nish25@gmail.com.

Excerpts from the interview with Dr Nischith and Dr Jagadeesh:

Q. There is a fear that India is emerging as a major reservoir for Chronic Kidney Diseases (CKD). Is this fear unfounded?

A. There is heightened awareness in India about the disease due to easy access to media. But it is true that India is the diabetic capital of the world and 1 out of 3 diabetics worldwide are susceptible to renal problems.

Q. Since diabetes is one of the main causes of renal failure, what is the present status of India as far as renal failure patients is concerned?

A. Incidences of kidney failure have doubled up in the last 15 years because there are large number of people with diabetics and hypertension in our country. Therefore the country is facing a huge burden in the form of Chronic Kidney Diseases and End-Stage Renal Failure and it can be said that nearly 25 to 40% of Indian population is at risk. Type II Diabetes is a known as a lifestyle disease and is often caused by sedentary lifestyle and unhealthy eating habits resulting in obesity. It is disturbing to note that it is increasingly affecting people in younger age groups though usually it affects people above 50 years. Among patients with diabetes we cannot generalize that they will all end up with renal disease. There are a group of diabetic patients who have not developed kidney problems even after several years.

Q. Apart from Diabetes and Hypertension, what are the other causes of renal failure?

A. Diabetes is the single most important but not the only cause of renal failures. Renal failure may be triggered by congenital disorder (hereditary disorder) of the kidney. People who are increasingly susceptible to chronic, untreated and repeated kidney stones also may develop kidney failure. Then there are other primary kidney diseases like inherited disorders namely polycystic kidney disease where the kidneys have the tendency to form cysts. The cysts may hinder the normal functioning of the kidney.

Q. Is it true that people in the coastal region are increasingly susceptible to kidney stones and cystic disorder?

A. Stone disorder is common among people in coastal regions due to the hot humid atmosphere. Cystic disorders are generally related to hereditary factors.

Q. What do you actually mean by kidney failure?

A. Kidneys serve as body’s filtration system. The amount of blood and waste purified by the kidney is about 120 ml per minute. If the kidneys are affected the amount of blood purified by them comes down drastically. Once kidneys lose the ability to purify, they fail to regulate certain chemicals in the bloodstream and would leak protein in the urine. Until the purification ability drops to 30 ml per minute patients usually don’t show any outward symptoms or manifestations of the disease. When the purification capacity drops down to less than 10 ml per minute the patient become acutely ill.

Q. Are there any stages of severity of renal failures in between these two highs and lows?

A. Strictly speaking according to current professional guidelines, the severity of chronic kidney disease is classified into 5 stages. Stage 1 of the disease is mildest with hardly any symptoms and stage 5 is the severest stage of the disease and may prove fatal if untreated. Stage 5 of Chronic Kidney Disease is called End-stage-Renal Disease (ESRD) which means total kidney failure and needs treatment to replace the work done by the failed kidneys. ESRD would be fatal without proper medical intervention to remove wastes from the bloodstream. Then there is acute kidney injury wherein patients suffer from sudden, temporary and sometimes even fatal loss of kidney function and may need renal replacement therapy.

Q. Is renal failure reversible?

A. Chronic kidney failure is an irreversible condition. If detected in stage I it is possible to bring it under control to a great extent and kidney biopsy may have to be done in some cases to determine the cause of renal failure and it may then be possible to offer disease specific treatment. But once kidney disease sets in it is generally progressive. Medication and dietary measures will help to slow down the progression of the disease. Transplantation to patients is considered as an option only in stage 5.

Q. Is it possible to detect renal failure in the initial stages?

A. If a person, especially those who are prone to kidney disease as mentioned earlier, undergo regular checkups it is possible to detect the disease in the early stage. Unfortunately, patients exhibit no symptoms or feel any discomfort in the initial stages. Only when the functioning of the kidney drops to less than 10 ml per minute the patient becomes acutely ill.

Q. What are the tests to be done to know the health of their kidneys?

A. A person has to undergo urine and various blood tests to know about theprotein and blood elements in their system. Urine sample tests are conducted for over a 24 hour period to assess protein loss.

Q. What are the symptoms patients with kidney disease normally exhibit?

A. As already said, in early stages a patient will not show visible symptoms of the disease. As the disease progresses the symptoms appear and gradually worsen. Once the problem becomes acute the patient may show severe symptoms of loss of appetite, loss of taste, decreasing urine output, breathing difficulty, especially on exertion and nausea and vomiting in severe cases. If untreated, these are followed by gradual loss of consciousness.

Q. What is the treatment procedure for CKD and ESRD?

A. Since renal failure is an irreversible condition the only option is to go in for dialysis or kidney transplantation. Treatment part also includes dietary changes and medication to relieve specific symptoms such as overcoming anemia and high blood pressure, which are critical to the process of treatment.

Q. Will you be able to describe the process of dialysis?

A. Dialysis is a process where the purification function originally done by the kidneys is carried out artificially with the help of a machine, which serves as an artificial kidney in the hospital. There are two types of dialysis – Hemodialysis and Peritoneal dialysis. In Hemodialysis patients should undergo dialysis treatment three times a week for about 4 hours on an average for every sitting.

In peritoneal dialysis the patient’s own abdominal lining is used as a blood filter. In this process a catheter is placed in the abdomen and a specially prepared solution is passed through it to remove waste products and excess fluids from the patient’s bloodstream. This is a daily process which patients can do at home after getting initial training from the hospital. This is slightly expensive as compared to hemodialysis. Those who are able to get a kidney donor can go for kidney transplantation. Patients may be offered any one of these treatment methods depending on the condition of the individual person concerned.

Q. Is dialysis an expensive process of treatment?

A. There are instances of patients who are dialysis for more than 10 years who continue to live a normal life except that such patients need to visit the dialysis centre regularly. This can be done in any hospital in any city. Mobility of the patient across hospitals is easily done with prior appointments. Every sitting of dialysis may cost anything from Rs. 650 to 1000 and require hospitalization for about 4 hours which means about Rs. 10,000 to 15000 needs to be spent for dialysis support.

Q. Among the three which is the best option?

A. Transplantation is the best bet and excellent option for patients simply because rehabilitation is almost complete in this case. The person affected can lead a near normal life and can even do hard labour. But the patient should get a proper donor to carry out renal transplantation which is not easy to get.

Q. What is Kidney Transplantation or Renal Replacement Therapy?

A. Kidney transplantation means surgically implanting a functioning kidney from a living donor or from a brain dead organ donor in the body of the patient suffering from kidney failure. When a person’s kidney is not able to keep him or her alive such patient should be given a replacement for carrying out the function of blood purification. This process is called Renal Replacement Therapy. The term RENAL REPLACEMENT THERAPY refers to all forms of treatment including Hemodialysis, peritoneal dialysis and renal transplantation. When a new donor kidney is implanted patients own native kidneys are usually not removed and the new kidney is placed just below the tummy.

Q. Who are the people eligible for donating kidneys?

A. Legally it is only the relatives like siblings, parents, grandparents, cousins and spouse are allowed to donate apart from brain dead donors (usually from fatal road traffic accidents), whose kidneys can be used for transplantation. The important thing is that the blood group of the donor and the patient should match. Moreover the hospital which conducts the operation should be authorized by the government to conduct renal transplant operations.

Q. We have heard of instances where kidney transplanted gets rejected by the patient?

A. Despite taking every conceivable effort to ensure the donor and recipient organs match, the risk of rejection is highest in the initial period i. e. first few days, first few weeks and months and years. Once the initial phase of 3 years is complete chances of rejection are not very high although it can occur at any time.

Q. Can the patient lead a normal life after kidney transplantation?

A. Rehabilitation of the renal transplant recipient is almost complete in most cases and they will be able to carry on life as any other normal person. But lifelong medication is a must for a kidney transplant patients and the cost of medicines may be up to about Rs. 10,000/- every month for the person who undergoes kidney transplantation. For the donor generally no medications are needed and they too can lead a normal life.

Q. What are the dietary precautions needed for a Chronic Kidney Disease and End-stage-renal-Disease (ESRD)?

A. Renal failure patients are advised a low in salt and low protein diet. Controlling blood sugar is a must for all patients with renal failure.

Q. What is your message to the people?

A. By controlling blood sugar and hypertension, half the battle against renal failure is won. Despite taking precautions there are people with an element of genetic susceptibility to renal diseases who need to be extra vigilant so as to prevent this disease. Even among diabetic people there is one group who are sure to develop renal failure due to hereditary predisposition (Familial clustering). Hence, regular checkups especially for susceptible groups, is a must.

Institute of Nephro Urology – the Exclusive organization for Renal Diseases

The treatment for Kidney problems - Kidney Replacement Therapy is an expensive process especially if done in private hospitals. Moreover, both dialysis and kidney transplantation require life-long medication, which is quite heavy on the pockets of the patients.

Many people may not be aware that there is an Autonomous State Government funded Institution in Karnataka which carries out dialysis and transplantation free of cost for people below poverty line and at reasonable cost for other middle class people. Institute of Nephro Urology is a premier organization in the field of Nephrology and Urology. The institute is located in the campus of Victoria Hospital, in Bangalore. The institution was set up in 2004 and dedicated to the general public in 2007. On realizing that an International standard Super-specialty care and research centre in the field of Nephro-Urology is the need of the hour the Government of Karnataka established this Institute.

The Institute was set up with the solemn objective of establishing to provide relief for Nephro-Urology diseases and it has been doing yeomen’s service catering to the needs of the poor patients. It was also established with the intent of providing high quality treatment for patients and encourage research in the field. The mission was to provide high tech treatment at low cost. True to its solemn objective the institute has in the last few years emerged as the premier Nephro-Urology institute in the state.

Dr G K Venkatesh, Ms, M.Ch, Director of the institute, has been the main force behind the institute and has played a pivotal role in making it a premier institute in the country. In a telephonic conversation with Daijiworld Dr Venkatesh stated that various treatments under different central and state government schemes are made available to patients from all over the state of Karnataka.

Renal disease patients with BPL card or income certificate can approach the Institute and meet the medical social workers. They have to get registered for both the donors and recipients at the institute and can go back. The process for transplantation will start within 2 to 3 weeks when the patient and the donor will be called to Bangalore to get admitted at the institute. The operation will be done completely free of cost and medicines worth more than a lakh will also be given free of cost for the patient for a period of 2 years. Patients will have to go to Bangalore every month to collect these drugs for compliance.

When asked what prompted Dr Venkatesh to start the institute he said “we though super specialty treatment cannot be provided in a general hospital and we thought a separate unit exclu sively for renal diseases would be greatly beneficial for patients suffering from this disease. Moreover there are chances of getting lost in a big hospital are always more. So we wanted to re-locate the institute in a specious campus and function as a nodal centre for all activities connected with Nephro Urology in Karnataka. The hospital conduct about 1800 to 2000 dialysis every month and 63 kidney

Transplantations have been carried out in 1½ years. While the operation and medicines is given free of cost the patient has to pay for the donor evaluation fee which comes to about Rs. 10 to 15,000. The operation which may cost anything between 3 to 10 lakhs is done free of cost at the Institute of Nephro Urology.

The institute has state of the art 4 major and 1 minor Operation Theatres with modern anesthesia equipment, Endo urological equipment, C-arm. These operation theatres are well-equipped to conduct Renal Transplantations. Those patients who are interested in availing the free renal disease treatment facility can contact the institute.

INSTITUTE OF NEPHROUROLOGY
Victoria Hospital Campus,
Bangalore- 02.

Email: nephrourology.institute@gmail.com

Website : www.nephrourology.in

Ph: 080-267 067 7 7 , 080-267 00527 , 080-267 02021

Dr G K Venkatesh – Mobile 98450 43209