Kidney disease burden and

available Renal transplantation

and Dialysis services in India
Dr. Sham Sunder
India: Kidney disease burden
India is the worlds 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: 203207

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:c197c203

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:c197c203

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:c197c203

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: 203207

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 18,00020,000
patients (10% of new ESRD cases) in India
get renal replacement therapy

Nephron Clin Pract 2009;111:c197c203

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: 203207

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: 203207

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: 203207
1st 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

 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

 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

2009 data: Kidney transplantation
2009 data: Kidney transplantation
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
India: Renal transplantation

NDT Plus 2010; 3: 203207

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%;
200007, 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: 203207

India: Dialysis centres
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 governmentprivate 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