One in three patients in the state suffer from diabetic nephropathy, a disease that damages the kidneys and is the single most important cause of end-stage renal problems.
Kerala has a high prevalence of diabetes at 16 to 20 per cent, which is double the national average. And with 50 per cent of these patients having some renal problem, including diabetic nephropathy, experts say the situation is already alarming and could go out of control in the coming years.
“It’s a huge problem. We would require three times the existing state budget and infrastructure if we were to provide complete treatment for diabetic nephropathy patients. So the main focus has to be on prevention and early detection,” says Dr Ramdoss Pisharody, principal of the Thiruvananthapuram Medical College.
While the risk factors for the progression of nephropathy are many, the important ones are duration of diabetes, glycemic (blood sugar) control, blood pressure, proteinuria (an excess of serum protein in the urine), genetic factors, smoking and protein intake.
“Some 50 to 60 per cent of cases coming to us have diabetic nephropathy and many of them require dialysis,” says Dr Jacob George of the nephrology department of the Medical College, Thiruvananthapuram. Most patients end up in this situation as they fail to keep blood pressure and sugar levels under control, he said.
Experts say the prevalence of diabetes in urban areas is as high as 17 per cent. But what is worrying is that in only 40 per cent of these patients is the sugar level under control. Fifteen per cent are not even under treatment. High risk patients need to be screened annually for micro albumin, comorbid factors, overt protein, serum creatinine, high blood pressure and coronary artery diseases.
Dr Martin T. Kurian Mappilachery, consultant nephrologist at Holy Cross Hospital in Kottiyam, says diabetic patients who have had the disease for between five and eight years have a high risk of getting diabetic nephropathy.
“Diabetic patients should keep fasting blood sugar levels below 126 mg dl and HbA1C below 7 per cent,” he said. Lifestyle modification, a healthy diet, reduction of salt for hypertensive patients and absolutely no smoking could bring down the risk considerably.
The Government, which has now woken up to the problem, has decided to open dialysis centres in all districts. Existing dialysis centres in medical colleges and general hospitals are being upgraded.
But experts say more than treatment, the need of the hour is to have an aggressive campaign focusing on lifestyle modification, early detection and prevention.