Global Dialysis Perspective: India

The number of deaths attributable to CKD in India rose from 0.59 million in 1990 to 1.18 million in 2016 (1). Data on incidence and prevalence of kidney failure remain estimates because there are no kidney failure registries. The Million Death Study estimated the number of kidney failure deaths to be 136,000 in 2015 (2). A 2018 estimate put the number of patients on chronic dialysis in India at about 175,000, giving a prevalence of 129 per million population (3). A systematic review estimated that about two thirds of all patients with kidney failure died without receiving dialysis in 2010 (4).The burden of kidney failure deaths in India is greater in comparison to other low- and middle-income economies with a similar sociodemographic index, suggesting an improvement in mortality rates in India is possible, even with the existing resources (1). Both in absolute and relative terms, the proportion of patients with kidney failure who have access to treatment and are covered by an insurance scheme is lower than China, the only country more populous than India.According to a 2012 report from the Indian CKD Registry, the most commonly identified causes of kidney failure were diabetes, hypertension, and GN, whereas the cause was not discernible in about 16% of patients (5). Dubbed CKD of unknown etiology, such cases are reported from all over the country, with the states of Andhra Pradesh, Odisha, Maharashtra, Goa, and Tamil Nadu reporting a particularly high burden (6). The exact causes of CKD of unknown etiology is a topic of ongoing research, with recurrent dehydration as a result of outdoor work in hot and humid weather, consumption of water contaminated with heavy metals, and exposure to pesticides being implicated most frequently (6).There are few data on the burden of comorbidities and complications …