More than one lakh patients are on dialysis every year in India. There are also more than one lakh new patients being identified every year and 70 per cent of them do not continue with dialysis as they are simply unable to afford the procedure. The recent case of Minister of External Affairs Sushma Swaraj’s diagnosis has brought into focus a problem many suffer from. While transplant is a good and easy option, due to less donors, the procedure is not being carried out for all. Also, with the Government’s Jeevandan scheme, organs from brain-dead patients are being used for these patients. Dr Sanand Bag, senior urologist and kidney transplant surgeon at Yashoda Hospitals explains the problem.
Q. What causes kidney failure, and can we stop it?
Diabetes (uncontrolled sugars), high blood pressure, inflammation and infection in kidney (glomerulonephritis), long-standing obstructing urinary stones and hereditary (polycystic kidney) disease are the major causes of kidney failure. Stringent control of BP and sugar through regular check-ups, proper dietary restrictions, periodic blood (creatinine) urine (proteinuria) tests and medication can prevent progression to dialysis-requiring stage or chronic kidney disease.
Q. Is kidney disease hereditary?
About 2-5 per cent kidney failures are caused by hereditary factors (e.g. poly-cystic diseases and alport syndrome).
Q. How do I know that my kidneys have failed?
The major function of kidneys is to filter out extra fluid and impurities from the blood. When kidneys don’t work, the toxins and fluid accumulate in the body causing uremic symptoms characterized by lethargy, high BP, headache, drowsiness, swelling in the face and feet, decreased urine output (at times increased urination during night in diabetics), loss of appetite, nausea and vomiting, itching and in severe cases, respiratory distress, seizures and unconsciousness. Diabetic and hypertensive patients on regular medication may not have many symptoms — routine tests reveal high creatinine in blood and increased protein excretion in urine, which goes up gradually with time.
Chronic kidney failure is not irreversible and needs regular check-ups and medication to combat symptoms, control BP and maintain good health.
When severe, either hemodialysis and peritoneal dialysis is available for temporary relief. Dialysis is a better alternative but 25 per cent of the patients on dialysis die annually from heart failure, infection or complications from the dialysis.
Q. How does a kidney transplant differ from dialysis?
During a dialysis session (3-4 hours), a machine filters toxins, extra fluid from blood with at least three sessions per week. Thus, patients usually have diet and fluid restrictions. Many people undergo dialysis while awaiting a kidney transplant, although pre-emptive transplants (without going for dialysis) is preferred if a suitable donor in family available.
Q. Who qualifies for a transplant?
There is no age limit — but people below 70 who are in a good state of health (fit for operation), are advised transplants. People harbouring disseminated (incurable) malignancies, a debilitating illness or chronic untreated infections are deferred from transplants. Those with treatable cancers can undergo kidney transplant after about two years following curative treatment. In cadaver donor program, transplant waiting list is prepared by point-scoring system based on age, expected survival, time on dialysis, PRA, and other factors.
Q. How must a patient cope with transplant?
After a transplant, the patient is put on immunosuppression medicines. This is because the immune system recognises the transplanted kidney as ‘different’ and may try to attack the organ. To prevent rejection, these medicines are given which have to be taken daily. Also frequent check-ups are required for two to three months after transplant.