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Expert Speak

Some Developments in the Realm of Managing Renal Failure.

Dr S Suresh AB ( Int Med),AB (Neph) Consultant Nephrologist

 

The incidence of Chronic Renal Failure or Kidney Disease is not as common as Coronary Heart Disease. However, because of the population density and the lack of adequate healthcare to match, there is a constant clamour for kidney transplants and treatment facilities in India. Long term care for kidney disease continues to be expensive, but there are a few factors that have brought some comfort for the patient, says Dr S Suresh AB ( Int Med),AB (Neph) Consultant Nephrologist at Sundaram Medical Foundation Chennai.

What is the typical profile of a person with Chronic Renal Failure?

It is tricky to stereotype, as kidney failure can affect people of any age or sex. Having said that, I would like to say we come across more male patients between the ages of 40 and 50. They are probably in service still. Often, they are people who have not paid enough attention or given adequate treatment for either chronic diabetes or chronic hypertension.

They come with a range of symptoms: puffiness of the face, swelling in the legs, poor appetite etc.

Have there been any recent breakthroughs in diagnostic methods, to make the detection effective, or to detect the disease in its initial stages?

Apart from increase in infrastructure facilities there has not been much in the realm of diagnostic methods that can be labelled a dramatic development.

We do a thorough physical exam, ask for urine and blood tests and an ultrasound scan of the kidneys. Some more specific investigations may be required before treatment.

The investigations help to reveal:

  • The presence (or absence) of renal failure.
  • The severity of the problem
  • The possible causes of its origin
  • The approximate duration for which the patient has been affected.

There is no cure, as of today, for End Stage Renal Failure. So what is the treatment approach that you undertake?

Treatment focuses on several aspects.

Firstly, we try to try to determine the cause and see if we can rectify that. For instance, if the patient’s kidney functions are suffering from poor control of diabetes, we try to correct that.

We then see if there are any complications like fluid retention (swelling in the legs, puffiness of the face etc.) and treat these too.

Though there is no cure except by way of renal transplantation, we try to delay the progression of the disease. Until a transplant is possible the patients are maintained on Dialysis.

Have there been any developments in the past five years that have brought some comfort to the Chronic Renal failure patient?

Yes there have.

For one thing, our understanding of the disease, especially the factors that trigger it and how it progresses, has improved.

There have been some marked improvements in the area of medication and treatment (if not in diagnosis or intervention).

What improvements have happened in the field of medication?

  1. We now use a class of drugs called ACE inhibitors that protect kidney tissue and slow down the kidney damage associated with diabetic kidney disease.
    Kidney functions are preserved longer (depending on type of kidney disease).
    The drugs are very effective, for instance, when used in the early stages for patients with Diabetes

  2. We have several safe and effective drugs to Blood Pressure under good control.

  3. We have better drugs to control nephritis (inflammation in the kidneys).

  4. We have more effective medications to treat anaemia and reduce the risk of heart problems, which happen because of Chronic Renal Failure.

  5. Chronic Renal failure causes abnormalities in the levels of minerals in the blood. This affects the bones, joints and muscles. The treatment for this has improved and the quality of the patient’s life has become better because of this.

How would you rate the quality of care available in India for patients with Chronic Renal failure?

What has widely impacted the field of Renal Care is the growth in infrastructure. We now have plenty of better-equipped hospitals and more expertise in areas like Renal Transplantation, Haemo dialysis and Peritoneal Dialysis

It would not be an exaggeration to say Tamil Nadu is the best-equipped state in the country for management of Chronic Renal Failure.

But treatment is still expensive…

I agree. But there is some hope. Medicines are more freely available and cost less today. (Drugs that control anaemia are a case in point.) Also more awareness brings more patients seeking care and this creates the need for more hospitals. Expanding infrastructure, insurance and patient preparedness to tackle this condition is creating an economic equation that is likely to favour the patient.

What percentage of persons who are diagnosed between 40 – 50 years of age continue with productive work as before?

Unfortunately this is low. As low as approximately 20%.

However, it must be noted that therapy is getting more and more patient-friendly and the quality of life has improved for the patient.

It is said that patients are deeply upset and often go through denial when diagnosed with kidney disease. What is the kind of counselling do you give your patients.

We tell the patients that treatment does protect the kidney, keeps it functioning for longer and prevents things from going worse rapidly. So the first thing the patient must understand is that it is not a hopeless exercise. He must be persuaded to take the treatment seriously, with a positive mindset.

Morbid fear of the disease, so often seen in patients, has to be discouraged.

We warn patients not to take other medication, be it alternative or allopathic, without consulting us.

Many patients look for Magical Remedies and consult quacks and practitioners of therapies that have not been proven in this field.

Are there some safeguards all of us can take to keep our kidneys functioning efficiently as possible?

Control your blood pressure.

If you are a diabetic, ensure tight control of your blood sugar levels.

Eat a well-balanced diet and exercise regularly.

Drink plenty of fluids (6-8 glasses of water per day).

Do not overuse over-the-counter medications.

Treat wounds and infections; follow your doctor’s instructions.

Limit exposure to heavy metals and toxic chemicals.

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