Chronic kidney disease in India

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*Department of Biostatistics. All India Institute of Medical Sciences. New Delhi &. **Department of Nephrology. Nizam's Institute of Medical Sciences University.

Indian J Med Res 126, November 2007, pp 485

Correspondence Chronic kidney disease in India

Sir,

renal registries; (v) develop renal epidemiology as a specialty ; (vi) reduce cost of reno-protective care ; and (vii) include renal disease as part of national integrated NCD control programme.

The interesting commentary ‘Chronic kidney disease in India - a hidden epidemic’ by Madhumati Rao and Brian J.G. Pereira1 sums up the state of affairs of chronic kidney disease (CKD) in India. Our observations on the glomerular filtration rate (GFR) in southern Indian population (Shyam et al, unpublished data) are consistent with the general belief that the normal ranges of GFR may be lower in Indian subjects. But we should verify whether the GFRs were truly lower in normal Indian population and if so whether such low levels pose a greater risk for development of CKD early. If low GFR does not pose any additional risk, it raises the question whether we require a different set of guidelines for classification of CKD.

C. Shyam, V. Sreenivas* & K.V. Dakshinamurty** Department of Nephrology Dr. Ram Manohar Lohia Hospital *Department of Biostatistics All India Institute of Medical Sciences New Delhi & **Department of Nephrology Nizam’s Institute of Medical Sciences University Punjagutta, Hyderabad 500082, India For correspondence e-mail: [email protected]

Apart from the barriers for management of CKD mentioned by Rao & Pereira, physicians’ knowledge on the natural history, markers for diagnosis and monitoring and therapies of CKD needs to be strengthened2. Therefore, it appears that appropriate changes in the medical curricula are called for, both at undergraduate and postgraduate levels.

References

Such a plan3,4 should include (i) government support for end stage renal disease programme; (ii) encouragement for clinical laboratories to report GFR; (iii) enhance facilities and infrastructure and personnel for dialysis and transplantation; (iv) establishment of

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1.

Rao M, Pereira BJG. Chronic kidney disease in India - a hidden epidemic. Indian J Med Res 2007; 126 : 6-9.

2.

Shyam C, Sharma B, Kamble U, Porwal YC, Dakshinamurty KV. Chronic kidney disease: Physicians’ views and approaches. Hong Kong J Nephrol 2006; 8 : 55-60.

3.

Shyam C, Sreenivas V. Chronic kidney disease: a missing component of integrated control of non-communicable diseases. Indian J Med Res 2005; 122 : 451-3.

4.

Shyam C, Dakshinamurty KV, Sreenivas V, Ram R. Chronic kidney disease: Need for a national action plan. Indian J Med Res 2007; 125 : 498-501.