Chronic kidney disease on the rise

With hardly any energy left, all Ramesh Lama can say is that he wants to live longer. “I don’t want to die,” said 25-year-old Lama, lying in the intensive care unit of the National Kidney Hospital (NKH) in the capital Kathmandu. But with both of his kidneys already badly damaged, he now has end stage renal disease (ESRD), an advanced form of life threatening chronic kidney disease (CKD). Lama is not alone. Over 10,000 Nepalese suffer from CKD due to increasing cases of hypertension and diabetes — the primary causes of kidney malfunction according to nephrologists (kidney specialists) of Nepal. However, the proportion of Nepalese with kidney-disease related problems was much higher, they added, estimated to be around 10 percent of the country’s 27 million inhabitants. “All over the world, kidney diseases are increasing but resources are not sufficient to address the problem,” said Dr Risi Kafle, one of the country’s eminent kidney specialists whose privately run National Kidney Centre (NKC) has the largest number of CKD patients. Expressing concern over the lack of kidney treatment facilities and doctors in many parts of the country, Kafle noted of the 10 nephrologists in the country, none were based outside the capital. Moreover, of the 10 hospitals treating patients with kidney failures, only three were outside the capital. Consequently, a large number of poor Nepalese cannot afford treatment due to their inability to incur the necessary travel costs, much less the treatment itself. “Barely 10 percent of the patients with kidney diseases can afford the cost of treatment. Many die in their villages due to lack of facilities,” public health expert Dr Ramkrishna Dulal, who specialises in kidney and diabetes, explained. The government had yet to give high priority to this health problem that was quite clearly on the rise, the health expert maintained. Kathmandu Medical College (KMC), one of the country’s best private healthcare facilities, confirmed that CKD was one of the fastest emerging public health concerns in the country given a rising prevalence of diabetic (diabetus mellitus) and hypertension. The prevalence of diabetes is about 14 percent among Nepalis above the age of 20 and 19 percent for those over 40, according to NKC. “This fact clearly means that another 15 to 25 percent of patients will have kidney failure,” said Dulal, who was especially concerned with the cost of treatment impoverishing many poor families further. And while the only treatment for CKD remains lifelong dialysis or kidney implantation, in a country where the per capita income is less than US $2 a day, few Nepalese can afford it. Each dialysis session costs nearly $50 and patients require three sessions a week. Meanwhile, Lama’s treatment for the last two years has cost his family everything. His father has already sold all their property – including their home - and family members are destitute living in a local Buddhist monastery near the capital. The family has run out of cash and are now appealing to the public through the media to provide funds to help save their son. There are thousands of patients like Lama in the impoverished Himalayan nation. According to kidney specialists dealing with CKD mortality cases, many of the patients arrive in their advanced kidney failure stage due to an acute lack of awareness about kidney disease and their condition worsens after many years of neglect.