Kidney health for all

The second Thursday of March of every year is observed World Kidney Day (WKD) with a theme. The theme of 2015 was Kidney Health For All, an audacious but simple to execute at the beginning. Without timely and proper management ultimate outcome of kidney diseases is either irreversible Chronic Kidney Disease (CKD) ending in End Stage Kidney Failure (ESKF) or Acute Kidney Insult (AKI).

Dialysis and Transplantation (D&T) are labeled as gift-of-life (GOF) management for both ESKF and AKI patients as any one of these provides a meaningful life to the victims, otherwise death is the only fate. D&T for EKSF are highly demanding of cost, technology and skill, and recurring affair. ESKF and AKI are the ultimate complications of common diseases like diabetes, hypertension, obstruction of urinary tract, infections, nephritis, drug abuse, febrile illness, diarrhoea, pregnancy, surgical complications, trauma, congenital anomalies and many others. Some of them are not primarily kidney diseases.

A rule-of-thumb observation reveals at any given time 10% of any population have early markers of kidney diseases, of which 10%  may develop CKD over 10 years, and 10% of them may end up over another 10 years in ESKF and may need D&T, the Alarming Rule-of-Ten (AROT). Not to overlook that only 10% of patients can afford or access to D&T and 10% of them can continue more than 10 months, the Frustrating Rule-of-Ten (FROT).

In a country of 150 million people, projection of this AROT is indicative of a insurmountable situation and FROT a great humanitarian disaster. So the theme of this year WKD is very pertinent. To ensure Kidney Health For All, there is a need of comprehensive concerted dynamic collaborative endeavor for preventive measures vis a vis rehabilitation of those who are already victims.

It is interesting that in some instances prevention for kidney disease may be the appropriate management of some common diseases in tandem for example diabetes, hypertension etcetera.

In our country, as the situation is worse, a dynamic social movement is necessary to consolidate the perceived need and customise the attitude for sharing and sacrifice followed by advocacy for a national law to develop, manage, collect and collate scattered resources and operate the fund to support ESKF patients.

This can be done by nominal levies on some services and trades. For example, there are 80 plus million cell phones in operation. Assuming one call per cell phone per day and adding one paisa per call every day, it will amount to Tk. 800,000, which is around Tk. 300,000,000 in a year. The actual figure will be much more. Established by national law, a ESKF National Support Commission may be entrusted to do the needful.

On own initiative doing two simple tests, serum creatinine and urine protein can reveal whether kidney is in health or not, preferably annually in asymptomatic persons. With other diseases one should insist the doctor to do these tests. Creatinine will tell about kidney function and urine protein about the structure.

Noteworthy that in early at reversible state kidney abnormality in most diseases will not produce any symptom to take care and thereby so doing may lead to prevention of the ultimate maladies in most instances. May be it is the appropriate reflection of kidney health for all.

The writer is an Internist & Nephrologist.
E-mail: ebyunus@yahoo.com