12 March 2010
By Ramya Kannan
No wonder then that the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations has taken on the diabetes monster, only a year after they took on hypertension (last year’s theme). This year’s theme is ‘Protect your Kidneys, Control Diabetes.’
In the online resources available on World Kidney Day (worldkidneyday.org) Paul Zimmet and Robert Atkins observe that in 2003, the ISN and the International Diabetes Federation launched a booklet called “Diabetes and Kidney Disease: Time to act” to highlight the global pandemic of type 2 diabetes and diabetic kidney disease. “Seven years later, the same message has become even more urgent,” the authors write.
“With the incidence of diabetes and hypertension on the rise, we are going to see the group of people with kidney disease swell,” says Sunil Shroff, founder, MOHAN Foundation. He also calls for lifestyle alterations, not only to stem the tide of the epidemic, but also to reverse it.
Zimmet and Atkins also state that primary prevention of Type 2 diabetes will require massive lifestyle changes in the developing and developed world supported by strong governmental commitment to promote lifestyle and societal change.
Georgi Abraham, nephrologist, and founder trustee of Tanker Foundation, says the idea is to tackle the issue at the very beginning. “Once the glomerular capillaries in the kidney start thickening there is not much we can do. The idea it to catch the disease early and stop its progression,” he says. The advice is also to check albumin levels in the urine on an annual basis, especially for diabetics. The simple dipstick, he says, only costs Rs.10.
V. Mohan, chairman, Dr. Mohan’s Diabetes Specialities Centre, says they start the awareness on renal complications as soon as tests show a patient is diabetic. “Immediately we start checking for albumin in the urine and test the eyes for retinopathy. In Type 2 diabetes, we are not sure about actual duration of the disease. Many people can miss diagnosis for a long time.”
Dr. Mohan recounts the case of a patient, a surgeon himself, who came for a consultation a week after he found he was diabetic. When the tests were run, they found he had already lapsed into kidney disease, had vision in only one eye and foot complications.
The importance of this year’s theme cannot be underestimated, says Rajan Ravichandran, director, MIOT Institute of Nephrology.
“If you go to any dialysis unit, you will find that 30–40 per cent of the patients are diabetic.”
As diabetes and HT blows up, so will kidney disease, he warns. Obesity is another issue that needs attention. Indians are prone to truncal obesity or paunches, he informs.
The waist–hip ratio is a critical indication of vessel damage. Measure yourself at the belly button and divide that figure by the measure of the widest point at the hip. The result should be less than 0.7 in women and 0.9 in men.