Nearly 18 million people, that's twice the number 10 years back, now have kidney diseases in Bangladesh, experts say. Worse, the number is rising, with 40,000 of them dying of kidney failure each year.
The experts blame the high figure on the rising trend of high blood pressure, diabetes and mindless use of drugs. "These figures are shocking and reveal the public health threat the country is facing," kidney expert Prof Harun-Ur-Rashid said. Experts suggest controlling diabetes and blood pressure, walking daily, avoiding extra salt consumption and quitting smoking to keep kidney diseases at bay.
At the same time, they urge the government to facilitate simple kidney screening at the grassroots through its community clinics and union level hospitals to ensure early detection of the people at risk.
SILENT KILLER
Kidney specialist Prof M A Samad prefers to call kidney diseases a silent killer. "Symptoms of chronic kidney diseases baffle people as they appear late, damaging almost 75 percent of a kidney." The frustrating thing, according to Prof Samad, is that over 50 percent kidney failure can be prevented, if detected early.
Blood and urine tests of people at risk, who are diabetic and have high blood pressure, can ensure early detection. He says, "People can get some clues through change in amount, color and frequency of urine, swelling in different parts of the body, fatigue and shortness of breath."
But the only way to be certain about the symptoms is to see a doctor. A Kidney Foundation survey showed 51 percent people are not aware that they have diabetes, 65 percent do not know they suffer from high blood pressure, while 65 percent do not know whether they are losing albumin with urine. Losing albumin means kidneys are not working properly. Another survey of Kidney Awareness Monitoring and Prevention Society showed 70 percent university teachers and students do not know about their kidneys and related diseases.
Prof Rashid says frequent consumption of over-the-counter drugs and indiscriminate use of antibiotics fatally damages the kidneys. Adulterated and arsenic-contaminated food is also raising kidney diseases in Bangladesh, he observes.
DISEASE MULTIPLIER
According to Prof Rashid, they need to take care of the heart of a kidney patient, as "people with chronic kidney diseases are 10 to 30 times more likely than healthy individuals to die of heart attacks and strokes". Even dialysis increases the risk of stroke, according to him.
Keeping in mind the important link between these two, the World Kidney Day 2011 on Thursday is themed on 'Protect your kidneys and save your heart'.
TREATMENT FACILITIES
Only awareness can help people to avoid permanent damage to their kidneys, says Prof Samad and adds that simple urine test of the people with high blood pressure, and diabetes can help detect kidney conditions early. He laments that there are only a handful of expert physicians and limited facilities to cope with the overwhelming number of kidney patients.
"We have only 75 kidney specialists and only 1,000 dialysis machines across the country," Prof Rashid, also president of Kidney Foundation said. Of them, only 100 dialysis machines are available in the public health facilities.
Almost 90 percent kidney patients die as they cannot afford treatment.
"People start dialysis to keep the kidneys functional, but 60 to 70 percent of them stop within three to four months for want of money."
Though a growing number of private hospitals can offer kidney treatment including dialysis, in the public sector only five to six big hospitals do so. Chittagong Medical College Hospital and Rajshahi Medical College Hospital outside Dhaka, and National Institute of Kidney Diseases, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University (BSMMU) in the capital treat kidney diseases.
Bangladesh Kidney Foundation, a not-for-profit entity, also offers low-cost treatment.
Prof Samad says government hospitals at unions should have facilities to provide primary treatment to kidney patients. "If necessary, they will send patients to specialists."
He points out that it takes only two to three days to train a doctor on primary detection and management of kidney diseases.
KIDNEY TRANSPLANT
Since most of the chronic kidney disease patients end up with kidney failure, kidney transplant rate is also rising in the country.Prof Rashid says the number of people needing kidney transplant has also doubled in the last decade, but only living donations cannot meet the demand.
Hundreds of people have to wait for a kidney as Bangladesh's Organ Transplant Act only allows kidney transplantation from close relatives and spouses.
But, there is a provision for posthumous donation. Lack of awareness as well as initiatives has been blamed for not collecting organs from patients who suffer 'clinical death'.
His comment can be illustrated by the case of Humayun Rashid, a single, currently on dialysis at a Dhaka hospital. He failed to manage a kidney as none of his few relatives is fit for live donation.
He now awaits a miracle.
At this point in time, at least 100 people are waiting at the Kidney Foundation for transplant, of whom only 10 have managed a relative to donate a kidney.
Ninety-six percent of the patients with total kidney failure have to live on dialysis for the rest of their life and only four percent can transplant a kidney, according to Prof Rashid of Kidney Foundation.
But, if everyone could transplant a kidney, they could live a normal life.
NATIONAL STRATEGY
Prof Matiur Rahman, who set up Bangladesh's first kidney department in 1973 at IPGMR (now BSMMU), says over the decades, diseases have changed their pattern with the demographic shift. "Earlier, infectious diseases were the main concern, but now non-infectious diseases have been an overriding concern," he says.
He suggests a robust policy to combat such diseases including kidney ailments.
"As there are links among kidney diseases, heart diseases and high blood pressure, there must be a national strategy to battle against those lifestyle diseases."
News Source: BDNews24