Diabetes and hypertension are the two most common causes of chronic kidney disease (CKD). Dr Anoop Misra, a leading diabetologist, talks to Gunjan Sharma about the increase in the number of patients suffering from chronic kidney disease and what one can do to protect one’s kidneys from the irreversible damage.  

What is the extent of chronic kidney disease in India? 

Recent data shows the overall age-adjusted prevalence of chronic kidney disease ranges from 11-18 percent in India. The severity of the disease is higher in Indians living in India than those settled abroad. About 3 percent of deaths in India are attributed to CKD. 

Diabetes and hypertension are the two main causes of kidney disease worldwide. What is the situation in India?

Hypertension, diabetes, and obesity are the major contributory factors. Indians are genetically prone to chronic kidney disease. Though the prevalence of the disease in India is similar to other countries, diabetes-related kidney disease shows a faster decline in functions in Indians. 

What are challenges that you face while dealing with diabetics with kidney disease?

Patients don’t realise the urgency to take care of their kidneys’ health in the initial stage of the disease. Its future implications and relationship with heart disease are also not known to them. Hence, most patients need a lot of counseling. After the onset of CKD, diabetes control becomes labile and difficult to control. Many drugs cannot be used for blood glucose control. Many a time, insulin is used for which patients are usually reluctant. 

What should a diabetic person do to protect his kidneys from damage?

Control of diabetes and hypertension is a must. Cholesterol levels should be brought under control. Some drugs can protect kidneys (ACE inhibitors, SGLT2 Inhibitors). Uric acid control and reduction of weight are also very necessary. 

Indians have an increased genetic tendency to kidney disease. So, any increase in diabetes will increase the number of people with CKD

Do all diabetics suffer from kidney disease over a period of time?

There are higher chances of kidney disease in patients with diabetes, who have poor control of blood sugar and hypertension, are smokers and obese. About 20-30 percent of patients with diabetes and hypertension develop some form of kidney disease over a long period of time. 

What are the factors responsible for the spurt in diabetes incidence in India?

Sedentary habits, intake of junk food and increase in alcohol intake. No clear gene has been implicated but a tendency to accumulate fat in the liver could be an important factor for an increase in blood sugar. But it must be kept in mind that Indians have an increased genetic tendency to kidney disease; so, any increase in diabetes will increase the number of people with CKD.

Diabetes was once considered a disease of the poor. That divide has long disappeared. Do you see any difference in the way diabetes has been managed by the different socio-economic classes?

Underserved populations need more time for counseling so that they understand long-term implications of diabetes. Mostly they are concerned about short-term diabetes control, and often stop their treatment when blood glucose levels become better. They need to be educated about the need for balanced diet and regular exercise. Besides, they should be given low- cost treatment, otherwise, they often go for ineffective alternative medicines. I have been repeatedly emphasising at every platform that physicians should, in general, use low- cost drugs and insulin for control of diabetes among underprivileged sections of society. Unfortunately, this is not happening and the result is uncontrolled diabetes with severe complications among them.