A 52-year-old grocery vendor had lived for years with diabetes and poorly-controlled high blood pressure. One evening he arrived at the emergency ward gasping for breath. Tests revealed advanced kidney failure. His kidneys had deteriorated to the point where they could no longer sustain life without medical support.
For several months the routine continued. Then one morning he arrived for his scheduled session only to learn that the dialysis unit had temporarily shut down because the town was facing a severe water shortage. He had to travel nearly 50 kilometres to find another centre that could continue his treatment. Until that day, he had never imagined that a water crisis could suddenly become a medical crisis. His experience highlights an often-overlooked reality: the treatment of advanced kidney disease is heavily dependent on environmental and infrastructural resources.
Healthy kidneys filter waste products continuously using only a few litres of water each day. In comparison, a single four-hour haemodialysis session requires hundreds of litres of purified water, substantial electricity and large amounts of disposable medical supplies. Over time, this creates significant financial, logistical and environmental burdens for health systems. For this reason, preventing kidney disease — or at least slowing its progression — has become one of the most important strategies in public health.
Why rolling back risk factors of chronic kidney disease is key to public health
Chronic kidney disease is increasingly common worldwide. Much of this rise is driven by the growing prevalence of diabetes, hypertension and obesity. Together, these conditions damage the delicate filtering structures of the kidneys over time, gradually reducing their ability to remove waste products and excess fluid from the body.
In diabetes, persistently high blood glucose injures the tiny blood vessels inside the kidney’s filtering units, known as glomeruli. Over time these vessels become thickened and scarred, allowing protein to leak into the urine and progressively reducing the kidney’s filtering capacity. This condition, known as diabetic kidney disease, is now the leading cause of kidney failure in many countries.
Hypertension harms the kidneys in a different but equally damaging way. The kidneys contain a dense network of small blood vessels that regulate fluid and salt balance. When blood pressure remains high for years, these vessels are exposed to continuous mechanical stress. Gradually they become narrowed and stiff, reducing blood flow to kidney tissue. This leads to scarring and loss of functional kidney units.
The relationship also works in the opposite direction: as kidney function declines, blood pressure tends to rise further, creating a harmful cycle that accelerates disease progression.
The importance of screening
Kidney disease develops silently. Many people remain unaware of the problem until significant damage has already occurred. In many cases, symptoms appear only after the kidneys have lost a large portion of their functional capacity.
This silent progression makes early detection essential. People with diabetes, high blood pressure, obesity or a family history of kidney disease should undergo regular screening. Blood tests measuring serum creatinine help estimate kidney function, while urine tests detecting small amounts of protein can reveal early injury to the kidneys.
Addressing root causes
Preventing chronic kidney disease ultimately requires addressing its underlying drivers. Good control of diabetes and hypertension remains the single most important intervention. Healthy diets, regular physical activity and maintaining a healthy body weight can substantially reduce the risk of developing these conditions. Reducing excess salt consumption, limiting ultra-processed foods and increasing intake of fruits, vegetables and protein-rich foods are widely recommended measures.
Equally important is ensuring that individuals already diagnosed with diabetes or hypertension maintain good control of their condition. Many patients either remain undiagnosed or struggle to adhere to long-term treatment, allowing complications to develop gradually. Strengthening primary care systems can help improve early diagnosis, ensure a reliable supply of medicines and provide counselling for lifestyle modification.
Maternal and early-life health
Prevention may begin even earlier than adulthood. Evidence suggests that maternal nutrition and birth weight can influence the risk of metabolic diseases later in life. Babies born with low birth weight may have fewer functioning kidney units, making them more vulnerable to hypertension, diabetes and kidney disease as adults.
Ensuring adequate nutrition during pregnancy and early childhood, therefore, contributes not only to immediate maternal and child health but also to long-term protection against chronic diseases.
Occupational and environmental factors
Occupational health is another important consideration. Workers exposed to intense heat and physically demanding conditions may face repeated dehydration, which can strain kidney function over time. Agricultural labourers, construction workers and others who spend long hours in hot environments are particularly vulnerable. Providing access to safe drinking water, shaded rest areas and regular breaks can reduce heat stress and dehydration.
Integrating kidney screening into routine health care, strengthening primary health services, promoting healthier diets and improving occupational protections can collectively reduce the burden of kidney disease.
(The author is Senior Assistant Professor of Nephrology, Madras Medical College)
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