Lifestyle disorders pushing India towards kidney disease epidemic, says renowned nephrologist

Kolkata | Chronic kidney disease (CKD) is emerging as one of the country's most pressing public health concerns, a renowned nephrologist said.

CKD is fuelled by lifestyle disorders like diabetes and hypertension and compounded by environmental and occupational factors, kidney ailments are no longer confined to the elderly or the urban elite, he said.

If left unchecked, kidney disease could soon take on the proportions of an epidemic, the nephrologist said.

Talking to PTI, Dr H Sudarshan Ballal shared his experience of witnessing how India's renal healthcare evolved from scarcity to scale but also watched new challenges emerge with unsettling speed.

"When I returned to India in 1991 from the US, there were just 800 nephrologists in the entire country. In fact, there were more Indian nephrologists practising in the US than in India. We used to call ourselves one in a million," Ballal recalled.

Three decades later, the situation has undoubtedly improved, with thousands of specialists and advanced treatment facilities spread across the country, he said.

"The situation is less grim than it was 30 years ago. But we still haven't covered the entire spectrum of patients who need treatment. Kidney disease is very common. Every year, nearly two lakh people develop severe kidney failure, and ten times more suffer from milder forms. Unfortunately, less than 25 per cent of them get any kind of treatment," Ballal said.

While access to nephrologists and dialysis centres has grown significantly, the affordability gap remains wide. Dialysis and transplants, the only options for end-stage renal disease, continue to be beyond the means of many families.

"Affordability is still a huge issue. In the early 1990s, only about five per cent of patients had insurance. Today, over 60 per cent are covered, but even then, the cost of long-term treatment is high," he noted.

India's rising burden of kidney disease is closely tied to its status as the diabetes capital of the world, Ballal, who is also the Chairman of the Medical Advisory Board of Manipal Hospitals and Director of the Manipal Institute of Nephrology and Urology, stated.

"The number one cause of chronic kidney disease globally is diabetes. So as diabetes increases, kidney disease inevitably follows. Unless we control the epidemic of lifestyle diseases, kidney disease will continue to rise. It's almost bordering on an epidemic," he said.

When asked about doctors identifying a mysterious condition called Chronic Kidney Disease of Unknown Origin (CKDU), increasingly seen among agricultural workers in Tamil Nadu, Andhra Pradesh and parts of Karnataka, Ballal said that the condition is deeply linked to the environment and working conditions.

He said, "I am happy that you are asking me this. These are young men working long hours in the heat. Some suspect dehydration, others point to soil contamination from fertilisers or pesticides. But no single cause has been identified yet. It's not contagious, but it's deeply linked to the environment and working conditions."

The nephrologist insisted that prevention must take precedence over cure.

"Clean drinking water, sanitation, and vaccinations save more lives than all corporate hospitals combined," he says. "If we strengthen primary health care, improve nutrition and public hygiene, we can prevent most of these diseases before they become life-threatening," he said.

For those already affected, he believes universal health insurance and stronger public hospitals are crucial.

"No one should be denied treatment because of cost," he said, adding that "Just like Medicare or the NHS, we need systems that ensure every citizen has access to care," Ballal said.

Despite the challenges, he is hopeful about the future. Ballal said emerging technologies, particularly Artificial Intelligence (AI), will transform the way kidney diseases are identified and managed.

"Technology and artificial intelligence will change how we diagnose and manage kidney diseases. AI can detect patterns, predict outbreaks, and even assist in treatment planning. The future won't replace doctors, it will empower them", he said.

"Kidney disease may not spread through infection, but it spreads through neglect of our habits, our health systems, and our priorities. Unless we act now, it will become an epidemic of our own making," he said.