Tomorrow, the 12th of March is World Kidney Day.
The Times of India had an article about what nephrologists are planning. As usual, the emphasis is on organ donation. Which is definitely not a bad thing. But two other things need increased focus.
One is the increasing number of people getting kidney disease. How does someone prevent kidney disease? What diabetics and people with hypertension, the highest risk groups for kidney disease should do to prevent getting kidney disease? The number of young people I see in dialysis units today is really alarming. It is clear that the number of people with CKD is increasing and that the average age of the CKD patient is falling. This needs to be addressed really soon.
The other thing that needs focus is the treatment modality. Dr. Peter Laird in an excellent post questions the designation of the transplant as the primary treatment modality in treatment of CKD.
A transplant is touted as the light at the end of the tunnel for a person with renal failure. It is packaged as the ultimate solution for all problems related to renal failure. The goal for everyone on dialysis seems to be a transplant. This is really not right.
A transplant is accompanied by so many complications and risks. I have seen people doing extremely well on dialysis (and I am not even referring to daily) go in for a transplant and then die. The issues are too complex and not understood enough. The number of parameters to monitor, what to do in case everything does not go on expected lines, dealing with the large number of possibilities, zeroing in on the right combination and dosage of drugs - there is no consensus or procedure to follow.
On the other hand, a convenient and suitable dialysis modality may be much, much better. There is no daily tension of watching what you eat and drink. None of the nervousness that follows anything even slightly out of the ordinary - a fever or a cough perhaps. Is my kidney being rejected? Not having to deal with this question every living moment of life.
I am not saying nobody should get a transplant. By all means, increase awareness about organ donation. Encourage transplants. But do not forget about better dialysis. Encourage people to try home dialysis if they are suitable. They might decide that they do not want a transplant.