World Kidney Day and Kidney Diseases in Nepal
World Kidney Day
World Kidney Day was initiated by the International Society of Nephrology, with the aim of raising awareness for kidney diseases. The first WKD was celebrated in 2006. Every year there is a different theme, like in 2010 the diabetes and kidneys, in 2011 the heart disease and kidney disease relations, and now, in 2012 the theme is promoting kidney transplantation. It will be celebrated on 8th March 2012. (see also: www.worldkidneyday.org )
It is important to notice, that to treat kidney diseases is not only difficult, but also very costly, so the best way to reduce the burden is prevention. Raising awareness is part of prevention.
Kidney Diseases in Nepal
Causes of kidney diseases in Nepal: hypertension, diabetes, chronic glomerulonephritis (inflammation of the kidneys over a long time, leading to permanent damage), kidney or urinary tract stones leading to obstruction, consumption of pain killers (non-steroidal anti-inflammatorydrugs :NSAIDs), etc.
Number of chronic kidney disease in Nepal: it is estimated, that in developing countries the number of new cases of end-stage renal failure (those, whose kidney is fully damaged and without dialysis or transplantation, cannot survive) is about 100-150 per million population per year. Calculating with the population of Nepal of 28 milllion, this number would be around 2800-4200 new patients per year needing dialysis or transplantation in Nepal.
It is also estimated, that for every patient on dialysis, there could be about 20 times more with kidney disease in earlier stages, not needing dialysis but maybe needing dialysis very soon in the future.
What can be done after the kidneys are damaged? After the kidneys are damaged, one need renal replacement therapy (RRT), which has three options. One: hemodialysis, done by a machine, in a dialysis center. Two: peritoneal dialysis, this is similar to hemodialysis, but no need to go to center, no need for machine, can be done at home, by the patient himself. Three: kidney transplantation.
- Hemodialysis – the most preferred way, now in Nepal almost every big cities have hemodialysis centers. In Pokhara, there are 3 centers today, with total 14 machines altogether, in contrast, 5 years ago there was only 2 machines and one center. In these 3 centers, there are approx. 70-80 patiens on regular hemodialysis. However, in a year, the number of new patients could be about 200-300, but most patients will not afford the treatment for long term, or may die earlier. Most patients are doing hemodialysis 2 times a week, some of them once a week, some of them comes only when they feel very sick.
- Peritoneal dialysis – this option is available only in few centers, the highest number of patients are in Dharan area. The patient will get one permanent catheter in the abdomen, through this there is saline water instilled in the abdomen, staying there for several hours, then drained, and new water instilled. Usually in a day they change the fluid 3 times. The patient is trained, how to do it, which is a very easy process, and fluids are delivered to the patient`s home, so it is also very convenient, no need to travel 2-3 times a week to the hospital. Especially good for patients living far from medical facilities. There are few backdraws of this option, need of special trained nurse staff, educator, there is a high risk of infection, and also not all patients will be fit for this treatment.
- Transplantation – the best available option, those, who get the transplant, will have much better quality of life, survive longer, and in long term, the costs will also be less than regular hemodialysis. The only problem is the initial cost of transplantation and the availability of donors, and also some patients may not be physically fit for the operation. In Nepal, there are two centers, where transplantation is done: Bir Hospital and Institute of Medicine, Tribhuvan University Teaching Hospital (TUTH). Transplantation in Nepal was started in 2008, approx. 50 per year is done in TUTH, and 30 per year is done in Bir Hospital. Only close relatives are accepted as donors.