The final stage of chronic kidney disease, called end stage renal disease, is when the kidneys are no longer able to remove enough wastes and excess fluids from the body . At this point, patients are put on dialysis or advised a kidney transplant.A team of senior doctors analysed the case sheets of 897 patients, including 268 women, who were on haemodialysis from 2003 to 2009 from five centres in the state and found that more patients with diabetes died when compared to those without diabetes. A lesser number of diabetics underwent renal transplants.
In the study, 335 of the patients were found to be having diabetes. Analysis of survival rates showed that 47% of the people with diabetes died when compared to 32% people without the disorder.Senior nephrologists say that people with diabetes respond slowly to most treatments and the disorder itself can worsen kidney diseases.
Worse, people with longterm diabetes may have multiple complications that will prevent them from having a renal transplant. In the study , 137 patients 31 diabetics underwent a re nal transplant. At least 10 were transferred to another form of dialysis called peritoneal dialysis and 234 were lost during follow-up.
The report published in the Clinical Kidney Journal concluded that diabetic patients have poor survival rates on haemodialysis, especially those from poor socioeconomic groups. “Due to scarce renal transplant facilities and poor survival rates of diabetic patients, prevention, early detection and management of diabetic CKD patients should be the way to go forward,” said senior nephrologist Dr Georgi Abraham.
Patient case sheets came from Chennai-based Kilpauk Medical College, Madras Medical Mission Hospital, Tamil Nadu Kidney Research (TANKER) Foundation, Pondicherry Institute of Medical Science, Puducherry, and Meenakshi Mission Hospital and Research Centre in Madurai.
Diabetes and high blood pressure are the two most common causes and account for most cases. Data from the Indian registry show that nearly 31% of all chronic kidney disease is caused by complications of diabetes.
Even when it is not fatal, the cost of treating end-stage kidney disease through dialysis or a kidney transplant is enormous. In the Tamil Nadu chief minister’s health insurance scheme, which covers more than 1.5 crore families in the state, renal dialysis is the most opted by policyholders although the cost of giving a heart patient a stent is several times higher.
Between January 2012 and May 2016, more than 2.21 lakh people have undergone dialysis at a cost of Rs 169.72 lakh. The charges do not include the inestimable costs to quality of life among patients with advanced kidney disease. In addition to dialysis, more than 60,000 people have opted for the treatment of kidney stones and renal transplant.
At least 3,000 people in the state have been wait listed for kidney transplant with the state cadaver transplant registry.
People with end-stage renal diseases can live for several years with regular dialysis, medical and lifestyle management, said the additional director of public health Dr T S Selvavinayagam. But doctors say the increasing incidence may bring down the chances of survival.