Why kidneys should be prioritised like heart health and obesity

Liver and kidneys are often equated to mother and wife respectively as both maintain a smiling face despite extremes of physical and mental stress. Nearly 90% of chronic kidney patients never experience any symptoms affecting their quality of life until the organ loses 80% of its function permanently. The only way to identify kidney disease is by voluntary testing for protein leak in the urine and the blood marker creatinine.

Identify the high-risk group

Two-population based studies, one among the general population and the other among agriculture workers, done by the Institute of Nephrology, Community Medicine and the Directorate of Public Health had estimated the prevalence of chronic kidney disease (CKD) in the adult population of Tamil Nadu at 8.4%. It identified diabetes and hypertension as the most common causes, accounting for 50% of the disease burden, with obesity being a forerunner of both.

The prevalence of diabetes and hypertension among the study population was 13.4% and 30.6% respectively, of which, two-third of the hypertension and 40% of the diabetes were diagnosed during the study enrolment itself. Which means people were simply unaware of their risks.

Then there was poor drug adherence to address health conditions due to financial reasons and inaccessibility to specialist services.

World Kidney Day 2025: The only way to identify kidney disease is by voluntary testing for protein leak in the urine and the blood marker creatinine.

Protecting the vulnerable

Chronic Kidney Disease of unknown cause (CKDu) affects people working in an outdoor environment like agriculture, brick kiln, salt pans, construction, coir industry and foundries. The most common link in all these blue-collar jobs are extremes of heat stress and highly demanding manual work. Both subject the individuals to repetitive dehydration episodes combined with exposure to environmental toxins like pesticides.

Our survey among agriculture workers showed that those who work more than 24.5 hours in a week are more vulnerable to CKDu. Those who had no formal school education are three times more at risk for developing CKDu. A study by IIM Bangalore showed people in the lower social order, in particular Scheduled Castes and Tribes, spend more than 75% of their working hours outdoors in at least 65 districts.

Steps at the community level

Though Tamil Nadu has a robust primary care system and most of the primary health centres are equipped to test urine protein leak and blood creatinine, it is often underutilised due to lack of awareness among primary care physicians and people. Time has come to start a chronic kidney disease registry at the level of PHCs (primary healthcare centres) and to include that in the list of non-communicable diseases of importance in the National Health Mission.

Training grassroot healthcare workers and village health nurses at every panchayat and urban municipal wards exclusively for non-communicable disease is crucial for early detection of high risk groups, ensuring continuous drug availability and adherence.

At the policy level

Screening for obesity should be added in the list of school health programmes while childhood diabetes and hypertension should be discussed as a priority in parent teacher association (PTA) meetings. As per the recent recommendation of WHO, use of low sodium salt in eateries and piloting the same through the public distribution system will have a significant impact on hypertension and kidney disease.

(Dr Sakthirajan Ramanathan is Assistant Professor of Nephrology, Madras Medical College)