Saving kidneys to save Nepal

At the National Kidney Centre in Kathmandu, a substantial number of the staggering 800 patients who come for regular kidney dialysis are migrant returnees from the Gulf and Malaysia. 

Last month alone, 90% of the 90,000 Nepalis who went abroad were migrant workers. Most of them went to West Asia. They are healthy when they leave, but are exposed to extreme temperatures, and many return with ruined kidneys.

Nepal is suffering an epidemic of renal failure due to the workers’ continuous exposure to excessive heat, chronic dehydration, harsh work environment, and the tendency to go for energy drinks immediately after returning from work. The problem will get worse in coming decades with nonsurvivable wet-bulb summer temperatures in the countries where Nepali migrants work. 

Truth be told, renal failure is not confined to migrant workers. Increasingly high numbers of young Nepalis are suffering from lifestyle-related ailments. Individuals as young as 25 are living with high blood pressure, fatty liver, and diabetes, among others.

In the past 40 years, Nepal has seen a dramatic transformation from a country with mortality mostly from infectious diseases to one where people are living longer but are dying due to lifestyle-related ailments. A 2019 study by the Nepal Health Research Council found that non-communicable diseases accounted for 71% of deaths in the country. 

Diabetes, high blood pressure, and the irrational use of painkillers are some of the main reasons behind this figure. Kidney failure can be prevented if diabetes and hypertension are controlled in the initial stages.

Renal health is very much linked to the quality of life and economy. Patients do not suffer alone, often they are the sole breadwinners and their condition will greatly impact their families.

As per the World Health Organization, 10% percent of Nepal’s total population (300,000 people) suffer from kidney issues, 30,000 of them are in the final stage, and 3,000 need dialysis or transplant every year.

The increasing burden of non-communicable diseases is a global phenomenon but developing countries like Nepal face a double whammy as we continue to battle preventable infections too.

The chances of survival for people suffering from renal failure are slim, but the good news is that the government provides dialysis and transplantation services free of cost. 

Currently, over 90 health facilities throughout the country provide free dialysis services to over 6,000 patients with renal failure. Over 3,000 patients have undergone kidney transplants since the service started about a decade ago, including a former prime minister and other senior government officials. 

Every year Nepal spends Rs2.11 billion on the treatment of patients with renal failure. Local governments also provide monthly livelihood allowances to those with kidney failure or undergoing transplants. This is the highest amount the government has been spending for any single disease. 

Even so, the focus is on the treatment of the 3,000 people living with kidney failure and scant attention has been paid to 270,000 others who suffer from some sort of kidney disease, and another 270,000 who are at risk of kidney disease.

Providing free dialysis service is not a sustainable solution. Authorities concerned should promote prevention, and encourage renal failure patients to opt for transplants. Despite the legal provision that allows any immediate family to donate a kidney, many with renal failure cannot find one. 

Road traffic accidents are one of the biggest causes of deaths today and a kidney from brain-dead donors is a viable option. But this requires increased awareness about organ donation.

Preventing kidney disease is the best way, and the first step is to launch awareness campaigns, the cost of which is minimal compared to the treatment cost of renal patients.

The public should be told about the dangers of obesity, excessive consumption of alcohol, tobacco, salt, and junk food as well as insufficient intake of vegetables and fruits. Regular exercise, drinking plenty of water, and cutting on sugar should be promoted.

Screening is crucial to early diagnosis and a lot of lives can be saved if testing for non-communicable diseases is made free once a year for all age groups. Even then, most Nepalis do not undergo tests unless it is an emergency. 

The government has established laboratories at the health post level to carry out the test, but very few make use of the service. People can monitor protein levels in urine and do a creatinine test, a measure that shows how well one’s kidneys are performing or filtering waste from blood. The tests cost just Rs100.

Above all, these awareness campaigns should be launched at the school and community levels so that we have an early chance to save every kidney from severe damage. Before things get worse, we Nepalis and Nepal can bring down the burden of non-communicable diseases, cut medical costs, and save lives.

Rishi Kumar Kafle is a senior Nephrologist and is the founding President of the National Kidney Center in Kathmandu.