1. Kidney disease burden and available Renal transplantation and Dialysis services in India Dr. Sham Sunder

2. India: Kidney disease burden India is the world’s largest democracy with a population of around 1.13 billion and faces tremendous challenges to provide basic healthcare for its masses NDT Plus 2010; 3: 203–207

3. India: Kidney disease burden The approximate –Prevalence of chronic kidney disease (CKD) is 800 per million population (pmp) – –Incidence rates of end-stage renal disease (ESRD) in India 232 per million population (age adjusted rate) Nephron Clin Pract 2009;111:c197–c203

4. India: Kidney disease burden The approximate –Prevalence of chronic kidney disease (CKD) is 800 per million population (pmp) – –Incidence rates of end-stage renal disease (ESRD) in India 232 per million population (age adjusted rate) Nephron Clin Pract 2009;111:c197–c203

5. India: Kidney disease burden The most common cause of CKD in population-based studies is diabetic nephropathy India currently has –820+ nephrologists –710+ hemodialysis units with 2,500+ dialysis stations and 4,800+ patients on CAPD [Continuous Ambulatory Peritoneal Dialysis] Nephron Clin Pract 2009;111:c197–c203

6. India: Kidney disease burden The Indian Chronic Kidney Disease (CKD) registry is an initiative by the Indian Society of Nephrology, and out of the latest total of 35 697 CKD patients, – –26 609 (74.5%) amongst the CKD patients were not receiving any form of RRT (renal replacement therapy) and – –only 880 (2.5%) received renal transplantation (RT) NDT Plus 2010; 3: 203–207

7. India: Kidney disease burden Nearly 3,500 transplants are done annually, the total number of cadaver donors being approximately 700 till now. –Thus, taken together, nearly 18,000–20,000 patients (10% of new ESRD cases) in India get renal replacement therapy Nephron Clin Pract 2009;111:c197–c203

8. India: Kidney disease burden It is estimated that >90% of patients with ESRD in South Asia die within months of diagnosis because they cannot afford treatment NDT Plus 2010; 3: 203–207

9. India: Renal replacement therapy centres India embraces a two-tier system for RRT including transplantation— 1. Government : dialysis, transplantation and follow-up are done free of cost for the poor 2. Private sector : two types: one where transplantation is done for a cost, which is non-profit-oriented, and one where it is done in corporate hospitals where the cost of transplantation and follow- up is high for the average Indian patient NDT Plus 2010; 3: 203–207

10. India: Renal replacement therapy centres Number of RT (renal transplantation) centers is 166, and – –35.6% are in the four major metropolitan cities The number of RTs performed yearly is 3.25 per million population in India Deceased donor transplantation is increasing because of the positive steps taken by – –Central and state governments, and – –Efforts of a few non-government organizations (NGOs). NDT Plus 2010; 3: 203–207

11. 1 st successful kidney transplant - Internationally Dec 23, 1954 –Peter Bent Brigham Hospital, Boston MA –Dr. Joseph Murray 23 yr old identical twin brothers –No immunosuppression used –d. 1962 due to disease recurrence (glomerulonephritis) N Engl J Med 2004;351:2761-6

12. India – renal transplantation The first ever human kidney transplant performed in India was done at the King Edward Memorial Hospital at Bombay in May 1965, –using a cadaver donor in a non-renal failure patient who had had hypernephroma The second kidney transplant in April 1966 - a cadaver donor once again - was carried out by the same team in a case of chronic renal failure –Followed by a similar cadaver transplant by Dr. Udupa and his team from BHU Varanasi J Postgrad Med 1994;40:158

13. India – renal transplantation The first successful Live Donor renal transplant in India was done at the CMC Hospital, Vellore in January 1971 –Johny and Mohan Rao reported an account of their first five successful renal grafts in Indian Practitioner in July 1972 –Though this was almost 17 years after the first “identical twin” transplanted by Murray et at in 1954, a successful start had been made in the field of human renal transplantation in India by the Vellore team They concluded that renal transplantation was feasible in India and has a definite future J Postgrad Med 1994;40:158

14. 2009 data: Kidney transplantation

15. India, however, slips to the 40th rank in the study of 69 countries in terms of number of transplants per million population, with –only three in a million getting the kidney in case of a renal failure

16. India: Renal transplantation NDT Plus 2010; 3: 203–207

17. India: Renal transplanation success rates Higher success rates with newer developments –1970s, the 30-year survival was 20%. –1980s, the 20-year survival was 55%; –1990s, the 10-year survival was 70%; –2000–07, the 5-year survival is 85%; Graft survival rates of 801 patients at the free-of- cost Government General Hospital are –92% at 1 year, –82% at 3 years and –75% at 5 years Positive attitude towards organ donation NDT Plus 2010; 3: 203–207

18. India: Dialysis centres

19. India: Renal transplantation future Living RT has been practiced in India for nearly four decades Deceased donor transplantation is on the rise as a result of government–private partnership Availability of cheaper generic immunosuppressive agents has improved long- term survival The transplant community in partnership with the government and private insurance should chart out a strategy to expand the transplantation programs to the less wellserved states in India