2-2
Chronic kidney disease as a public health problem in India: Current Status of surveillance programs
Vivekanand Jha

Department of nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Chronic kidney disease (CKD) and end stage kidney disease (ESRD) are emerging healthcare public health problems in developing countries and need changes in health care policy. We estimated ESRD incidence for four consecutive years amongst 572, 029 subjects in the city of Bhopal. A total of 346 new patients were diagnosed, with annual crude and age-adjusted incidence rates of 152 and 232 pmp respectively. The mean age was 47 years and diabetic nephropathy was the commonest cause. We also evaluated the referral patterns of ESRD in our hospital. Out of over 1100 patients, 73% sought medical care for the first time less than 3 months before the diagnosis of ESRD. These patients had higher frequency of malnutrition, and lower family incomes and limited access to healthcare, and were more likely to have severe hypertension, fluid overload, hyperkalemia and acidosis, needing emergency dialysis.Surveillance programs to establish CKD burden in the community include the Kidney Help Trust Program of Chennai, the Screening and Early Evaluation of Kidney Disease (SEEK) program and other local programs. Approaches include community-based, screening at health camps and cluster sampling. The Chennai rural program found the prevalence of hypertension, diabetes and CKD at 5%, 3.6% and 1% respectively. Amongst urban population of Delhi, the prevalence of CKD was 0.8%, hypertension 23% and dipstick positive proteinuria 5%. In health camps organized in tribal areas, we found the prevalence of hypertension, diabetes and proteinuria were noted in 31%, 20% and 9% respectively. To conclude, the burden of CKD and its impact on cardiovascular mortality and morbidity is unknown in India. Small surveys indicate high prevalence of uncontrolled hypertension and diabetes. Changes in healthcare policy, and increased involvement of government and non-governmental organizations in development of community surveillance and treatment programs are essential to reduce disease burden on the community.