Times of India
25 March 2010
Shailvee Sharda
Lucknow, India

Metabolic changes emanating from kidney due to diabetes ultimately manifests into a heart or brain problem. Data gathered from the National Chronic Kidney Disease Registry reveals that a whopping 96% of kidney patients develop cardiovascular problems towards the end stage of the disease. A body of international literature and trends from the out patient department of Sanjay Gandhi Post Graduate Institute of medical Sciences (SGPGIMS) suggest that over 75% patients suffering with chronic kidney diseases (CKD) have definite heart problems. Notably, CKD is a lifethreatening condition which leads to complete renal failure besides causing other complications.

Head of nephrology department, SGPGIMS, Prof Amit Gupta said: “when kidneys fail, fluid and toxins increase in the body, thereby affecting the functioning of heart. Experts across the world now see CKD as a major risk factor to chronic artery disease.” He added that kidney diseases in a large majority of patients was a result of diabetes which affects the blood vessels and the filtering mechanism of kidneys. This has a cascading effect on the vessels in the heart and the brain. “Need of the hour is to assure that the two problems are not compartmentalised.. experts should work as a team,” he said.

Specialists studying the cardio-renal syndrome believe that the problem is inter-related. This means heart problems can be accelerated by bad kidneys and vice-versa. Endocrinology experts say that among diabetics, sometimes symptoms of heart disease surface even before the symptoms of kidney diseases. Still, the cause of malfunctioning is not attributed to the kidney. Reason: diabetes and not the kidney malfunction caused by it is taken to be the culprit. This adds to the severity of a patient. This may be attributed to the lack of awareness. Estimates show that by the time patients suffering with CKD approach doctors, more than 50% of their kidney is already damaged.

The NKDR hints towards a bigger concern, which is: “not many kidney patients were checked for cardiovascular problems before they reached the advance stage of kidney failure. Not only this, cardiac problems intensify as the kidney disease progresses.” According to the figures, little above 3% of patients who were in initial stages of CKD had developed heart problems. But, the percentage went up as 19.7% of those in third stage of kidney disease had cardiac problems, 28.7% of those in fourth stage and 48.5% of those in the end stage of renal failure were suffering from heart ailments.

Dr SRS Yadav of Balarampur Hospital stresses on early detection and prevention of renal problems. This is important knowing that the available treatments — dialysis and kidney transplant — are costly and unaffordable for over 80% of patients. So, in case you have a kidney problem, be cautious about your heart too.

On the Rise
The city has witnessed a four-fold increase in the number of people suffering from common renal ailments in the past one decade. A similar rise has been witnessed in the number of people suffering with endstage renal diseases. Around 40% of the advance renal failure cases seen at SGPGIMS are diabetics while another 30% become renal disease patients as a fallout of high blood pressure.

Side-effects
With India being diabetes capital of the world, kidney diseases will increase in leaps and bounds. Doctors in city’s government hospital estimating a three-fold increase in the number of persons suffering with hypertension in the past one decade. Shockingly, 90% of the people come to know about their condition incidentally.

Doctors at CSMMU and SGPGI say that picture is equally gloomy for diabetes too. They see some 300 patients in a single day, of which 40% are new cases.

Threats
But the country is unprepared to meet the upcoming challenge. People aren’t aware of the primary symptoms and reach doctors when situation slips out of their hands.

“The gravity of the situation could be estimated from the fact that of all the patients in need of dialysis, only 22.5% receive the treatment,” stated Dr SRS Yadav, consultant nephrologist at Balrampur Hospital.

WHO estimates show that over 2,00,000 persons in India develop terminal kidney failure annually.