World kidney day is celebrated every year on the second Thursday of March. The theme of this year is ‘Advancing equitable access to care and optimal medication practice’. The first Department of Nephrology in India was started at the Government General Hospital and the Premier Institute of Madras Medical College in Tamil Nadu in December 1971. The State has crossed many milestones since, including running a successful dialysis programme under the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) — only Tamil Nadu and Kerala run a hemodialysis programme at government hospitals without opting for the PPP model — and delivering peritoneal dialysis bags at the doorstep of patients through the Makkalai Thedi Maruthuvam scheme, launched by Chief Minister M.K. Stalin in 2021 to provide healthcare at the doorstep of patients including screening, drug delivery, and palliative care. But there is still a long road towards the goal of ensuring kidney health for all.
Chronic kidney disease is the fifth leading cause of mortality in Tamil Nadu. This means that Tamil Nadu needs special attention compared to most other States. A recent step survey, conducted by the Institute of Nephrology and Institute of Community Medicine, Madras Medical College, estimated chronic kidney disease to be prevalent in 8.4% of the adult population of Tamil Nadu; 0.3% will require dialysis immediately. With diabetes and hypertension increasing in the population, the burden of chronic kidney disease will only increase. This will impact not only the health of the people, but also the economy. Every year, the Tamil Nadu government spends more than ₹100 crore for hemodialysis alone for the CMCHIS; this is the highest amount being spent on one disease.
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The need of the hour is to check blood creatinine levels to assess kidney function and use the dipstick method to check whether there is excess protein in urine among high-risk populations, in primary care. Further, the people of Tamil Nadu are also prone to chronic kidney disease of unknown origin. This is still an enigma as it is more common among people working in agriculture, salt pans, brick kilns, and other industries which require outdoor activity. A high number of people are involved in agricultural activities in Tamil Nadu, so they could be prone to this. Though there are symptoms for every disease, unfortunately, chronic kidney disease, much like diabetes and hypertension, predominantly remains asymptomatic and warrants a screening programme, which should be included in screenings for non-communicable diseases.
The State government has devised a mechanism to ensure that there are many super specialty doctors in government-run hospitals. There is internal reservation for those working in primary health centres and government hospitals to pursue specialty medicine. Though Tamil Nadu has the highest number of super specialists (900 doctors across various disciplines) in government hospitals, it has qualified nephrologists in only 20 medical colleges. Nearly half these have only one specialist. A disease with a prevalence of 8.4% needs at least two qualified nephrologists in every medical college. Further, end-stage kidney disease can be prevented if appropriate treatment is given at various stages of chronic kidney disease (classified as stage 1 to 5). This will save opportunity cost.
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The government has done commendable work through the Makkalai Thedi Maruthuvam scheme by delivering medicines for diabetics and hypertension at the doorsteps of individuals above 45 years of age. This scheme has covered more than 1 crore people so far. But it has to be strengthened further to include drugs for chronic kidney disease. All those with non-communicable diseases need lifelong medication. This scheme not only cuts the indirect cost of travel and wage loss for people who have to go get the drug on a specified day, but also ensures good adherence to medication.
Mr. Stalin has been emphasising that health and education are the two eyes of a government following the Dravidian model. He has ensured reasonable steps in every corner to achieve health equity. Similar to diabetes and hypertension, chronic kidney disease also needs prioritisation so that Tamil Nadu can achieve kidney health for all.
Sakthirajan Ramanathan is Senior Assistant Professor of Nephrology, Madras Medical College
