World Kidney Day: Interview with Dr. C. Arvind – eminent nephrologist and kidney transplant expert

March 14, 2019

March 14 is observed as World Kidney Day and the theme this year is “Kidney health for everyone, everywhere”. Every year on World Kidney Day, awareness campaigns, programmes and discussions are conducted worldwide about the importance of kidney health, kidney diseases and risk factors. On this occasion, Dr. C. Arvind, senior consultant nephrologist and transplant physician, The Bangalore and Sagar Hospitals speaks to our correspondent Odeal D’Souza about kidney health.

Dr. C. Arvind graduated in medicine from the Government Medical College at Mysore with distinction in 1989. Thereafter, he went on to pursue his post-graduation (DNB) in General Medicine in Chennai. He was awarded the Commonwealth Scholarship ODASSS to undergo training in Nephrology at the Hammersmith Hospital, Royal Post-Graduate Medical School in London, U.K. He then completed the Diplomate in Nephrology Examinations of the University of London with distinction in 1995.

Over the next five years, he worked as a nephrologist at the Singapore General Hospital gaining considerable experience in this field. Following his return to Bangalore in 2003, he signed up with the The Bangalore Hospital, Agadi Hospital, The Sagar Hospitals and the Sharada Dhanavanthari Charitable Dialysis Centre as a consultant nephrologist. His interested fields are Continuous Ambulatory Peritoneal Dialysis (CAPD), Acute Care Nephrology and Renal Transplantation.

What are the current statistics for kidney diseases in Bangalore, Karnataka and India?

Chronic Kidney Diseases (CKD) cause at least 2.4 million deaths per year worldwide and has now become the sixth leading cause of death. The prevalence of CKD in India ranges from 6 to 17 percent of the population in different studies. Two of the most common causes are diabetes and high blood pressure. India currently represents 49 percent of the world’s diabetes burden, with an estimated 72 million cases, a figure expected to almost double to 134 million by 2025.

The prevalence of diabetes is 6 to 8 percent. The crude prevalence of hypertension is 25 percent. The NCD Risk Factor Collaboration (NCD-RisC) suggest that between 1980 and 2014, the age-standardised diabetes and hypertension prevalence among men in India grew from 3.7 percent to 9.1 percent and 24.5 percent to 26.6 percent, respectively, and among women from 4.6 percent to 8.3 percent and 22.7 percent to 24.7 percent, respectively.

While diabetes was most prevalent in south India as well as in Delhi and West Bengal, hypertension prevalence tends to be the highest in the north Indian states of Punjab and Himachal Pradesh, the southern state of Kerala, and the northeastern states of Sikkim and Nagaland. Kidney disease hot spots have been reported in some parts of India, especially in Andhra Pradesh, central Odisha, Puducherry and Maharashtra, but these have not yet been substantiated by systematic studies.

The numbers of CKD patients in Bangalore and Karnataka are on the rise and this is reflective of what is happening in India as a whole. A recent study from a rural belt (rural Shimoga) of Karnataka showed that the population there had a mean age of 39.88 years with 3.82 percent prevalence of diabetes and 33.62 percent of hypertension. Authors found a 6.3 percent prevalence of CKD stage 3 which is the highest reported till date by any Indian worker. It is disturbing to note the high prevalence of hypertension in a rural setting where over 75 percent population had normal or low Body Mass Index (BMI).

Can kidney diseases be avoided through diet and lifestyle? What are the ways in which we can keep our kidneys healthy?

Although genetic susceptibility is a key factor contributing to the onset of diabetes (the South Asian population is four times more likely to develop the disease than Europeans), environmental factors including diet have been found to contribute over 50 percent of the risk.

As economic growth has spread across India, studies have shown that this results in an excess of calories, mainly from refined carbohydrates, in both the rural and urban population. White rice consumption, due to its high-glycemic index which spikes insulin levels, was strongly linked to a risk of Type 2 diabetes in the Indian population in one study.

Therefore lifestyle modifications are needed. Lifestyle modifications like making healthy food choices, limiting your salt intake, maintaining a healthy weight, controlling your cholesterol levels, etc. can reduce your chances of getting diabetes and hypertension,  and in turn decrease the risk of CKD. Making physical activity part of your daily routine is important. Exercise regularly. It can help reduce your risk of developing kidney disease by keeping your weight under check and also helping lower blood pressure and blood sugar. Yoga has been shown to reduce blood pressure and is another excellent form of exercise.

India has hot summers and the heat stress is a factor in causing CKD (a unique form of the disease called CKDu), and hence drinking enough clean water to keep oneself well hydrated definitely helps.

What are the new surgical procedures that have emerged in the field of Nephro-Urology?

The fairly recent surgical procedures that have come up in the field of Nephro-Urology include laparoscopic and robotic surgeries for donor nephrectomy. This helps because there is lesser bleeding, lesser time spent in the hospital and quicker healing.

Endoscopic urological surgery in treating kidney stones and other disorders is growing in leaps and bounds.

Another new surgical breakthrough that is yet to reach Indian shores is the new endovascular technique for AV Fistula creation (a surgical connection made between an artery and a vein) for CKD patients who need dialysis. This procedure seeks to bypass open surgery to form an AV fistula by allowing the operators (surgeons and interventionalists) to create a functional access through an endovascular approach. The procedure involves the use of ultrasound-guided access into the venous and arterial system in the arm, which is followed by fluoroscopic localisation of two catheters (arterial and venous). The catheters are aligned via a magnetic mechanism and a radiofrequency electrode is then used for the final step of fistula creation.

How far has India progressed in kidney disease treatments?

India is up there among the best as far as treatment of kidney disease is concerned. Infact surgeons from India went to the UK to train their UK counterparts on the intricacies of robotic donor nephrectomy.

There are lacunae though. As the old adage goes ‘prevention is better that cure’. We need preventive programmes on a massive scale and education of the general public to reduce the prevalence of diabetes and hypertension. Education and implementing of screening programmes at the PHC/GP level becomes very important.

What is your message for everyone on World Kidney Day?

“Kidney health for everyone and everywhere” is the slogan for this year’s World Kidney Day. Kidney Health for Everyone Everywhere calls for universal health coverage (UHC) for prevention and early treatment of kidney disease.

I would appeal to every family member of any patient who has diabetes/ high blood pressure/ CKD to screen himself/herself for the presence of diabetes and high blood pressure. Everyone should regularly do two simple tests – a blood test called Serum Creatinine and a urine test called Urine for Protein to make sure that your kidneys are healthy and functioning well.

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