Chronic Kidney Disease (CKD) is silently creeping into the lives of millions across India, affecting an estimated 14 crore people. Often overlooked until it's too late, CKD is emerging as a major health crisis, straining an already burdened healthcare system. With limited treatment options, overcrowded government hospitals, and a severe shortage of donor kidneys, countless patients are left fighting a losing battle.

Despite the government's commendable efforts to set up dialysis services at district hospitals, the ground reality remains bleak. To shed light on the growing burden of CKD and the challenges surrounding its management, Drug Today Medical Times Correspondent Rohit Shishodia engaged in an insightful conversation with Dr. Sandeep Mahajan, Professor in the Department of Nephrology at AIIMS Delhi, a leading expert in the field.

DTMT: What are the early warning signs of kidney disease that people should watch out for?

Dr. Mahajan: One of the biggest challenges with kidney disease is that it often progresses silently. In the early stages, there are usually no noticeable symptoms. The kidneys can lose up to 50%-60% of their function without any warning signs. It's only when the damage becomes significant—above 60%—that symptoms like swelling around the eyes and feet, fatigue, fluctuating blood pressure, sudden drops in blood sugar levels, low appetite, and reduced urination become visible. By that time, the disease has already advanced.

DTMT: What are the primary culprits behind the rising CKD cases in India?

Dr. Mahajan: The majority of CKD cases—around 60%-70%—are driven by diabetes and hypertension, especially in people over 40. These two lifestyle diseases are becoming increasingly common in India due to changing diets, stress, and sedentary lifestyles. Other contributors include kidney stones, prolonged use of painkillers or other medications, and recurrent urinary tract infections. Genetic disorders like polycystic kidney disease also account for about 10%-15% of cases.

DTMT: Many people think kidney stones are harmless. How can they lead to chronic kidney disease?

Dr. Mahajan: Kidney stones are more than just painful—they can be a gateway to chronic kidney disease if left untreated. Stones can block the flow of urine, causing pressure and damage to the kidneys. People with a history of kidney stones have a 10% higher risk of recurrence every year. Over time, recurrent stones combined with urinary infections can permanently impair kidney function. Even after treatment, regular follow-ups with ultrasound screenings are essential to catch new stones early and prevent further damage.

DTMT: What should people know about creatinine levels and GFR in assessing kidney health?

Dr. Mahajan: Creatinine is a key marker of kidney function, but it's not a perfect early indicator. Abnormalities often appear in blood tests only when more than half of the kidney function is already lost. Normal creatinine levels range between 0.5 to 1.2 mg/dL, but this can increase with age. GFR, which estimates how well the kidneys filter waste, is a more reliable measure. High-risk groups—such as diabetics, people with hypertension, or those with a family history of kidney disease—should undergo regular blood and urine tests to monitor GFR.

DTMT: There's a lot of confusion about how much water one should drink daily. What’s your advice?

Dr. Mahajan: The idea that everyone needs to drink a fixed amount of water each day is a myth. Water intake should be based on individual thirst and needs. However, people prone to kidney stones or those with infrequent urination should increase their water intake to prevent concentrated urine, which increases the risk of stone formation.

DTMT: Can you explain the difference between acute and chronic kidney disease?

Dr. Mahajan: Acute Kidney Disease (AKD) happens suddenly, often due to infections, dehydration, or excessive use of medications like painkillers. While AKD can sometimes be reversed, it may leave the kidneys permanently weakened if not managed properly. If the kidneys recover only partially—say up to 60%-70%—the patient remains at high risk of developing CKD. Chronic Kidney Disease, on the other hand, is a gradual and irreversible loss of kidney function that worsens over time.

DTMT: When does a patient require dialysis or a kidney transplant?

Dr. Mahajan: Dialysis and kidney transplants become necessary when the kidneys can no longer filter out toxins and excess fluids on their own. This typically happens in the final stages of CKD, when kidney function drops below 15%. Dialysis helps remove waste from the body, but a transplant offers the best long-term outcome. However, due to the severe shortage of donor kidneys in India, many patients face long waits or are unable to get transplants at all.

The rising burden of CKD in India highlights the urgent need for greater awareness, early detection, and preventive care. While the government's expansion of dialysis services is a step in the right direction, addressing the root causes—such as diabetes, hypertension, and lack of organ donors—requires a more comprehensive approach.

Encouraging regular health check-ups, promoting healthy lifestyles, and boosting organ donation initiatives can go a long way in curbing the devastating impact of CKD and giving patients a better shot at life.