Wednesday, 20 March 2013

CKD- The Silent Killer You Haven’t Heard About

Radha had been married a little over a year and was beginning to settle into the pulls and pressures that came with being a new bride in India. The gentle and sometimes blunt reminders from relatives on both sides, about time slipping by and the need to have children early, didn’t really concern the 29 year old IT professional or her husband. They were young and healthy and even though they had been trying to conceive for a few months, all the literature available online assured them that there wasn’t any cause for worry. So, when she reluctantly scheduled a visit to the infertility specialist at the prodding of her mother, it was more to avoid being nagged, than out of any real concern. Her first shock came when the doctor told her that her Blood Pressure (BP) was high. But when her blood reports came in and the doctor told her that her kidneys seemed to have failed, her world fell apart. Since that fateful day, chronic kidney disease (CKD) had completely taken over her life.

The kidneys are wonderfully complex organs that perform tasks vital to our normal well being. Each of our 2 kidneys work in tandem to clear the blood of excess waste and fluid that result from our diets, keep the chemical composition of our blood within normal limits and help maintain the health of our bones and manufacture red blood cells. Tiny filtering units, around 1 million in each kidney, called nephrons, keep plugging on regardless of the insults we pile on. Amazingly, all of this work can be done just as well, in a normal person, by just one kidney, which is what makes kidney donation possible. Even when some nephrons get damaged, the remaining normal nephrons work even more efficiently to compensate for the loss.  And this is why kidney diseases are a silent killer. The kidneys are so efficient at compensating for damage, that we seldom make a diagnosis early in the course of the disease.

In India, Diabetes and Hypertension together are responsible for about 50% of the cases of CKD.  And due to changes in our lifestyles and improving socio-economic standards India has seen a sharp rise in patients with Diabetes and Hypertension. Both, lack of awareness and sketchy access to quality medical care puts a large number of these patients at risk of developing complications associated with these chronic diseases, the most silent of which is CKD. Given this situation the only real precaution that can be taken against CKD are the following:

Regular and strict control of diabetes and hypertension
Avoidance of indiscriminate over-the-counter drug consumption
Regular check-ups for early detection of kidney disease especially in at-risk patients including diabetics, hypertensives, those with unexplained leg swelling or urinary disturbances and those with recurrent stone disease
Early referral to a kidney specialist for specialized care

The slow but inevitable progression of CKD to End Stage Renal Disease (ESRD) makes it even more important that the health officials of our country take notice of this disease and formulate policy that allows the easy setting and running of dialysis units by private players or enable subsidized access to dialysis facilities to patients as has been done by the YSR government in Andhra Pradesh. Increasing access to dialysis facilities allows these patients to remain functional and facilitates the possibility of a new lease of life through a kidney transplant at some point in the future.

All of this brings us back to Radha. Twice a week dialysis meant that she lost 2 days of work in a week and soon had to resign from her job. All the restrictions in food and fluid intake meant she could no longer indulge in her favourite roadside chaats.

The worst was yet to come. The doctors soon informed her that she had no hope of conceiving unless she received a kidney transplant. The search for a donor turned out to be one of the most eye opening experiences of her life. Now the Indian law restricts organ donation to close relatives. To Radha's bad luck even though her husband and parents were willing, they were rejected as medically unfit. Her older sister who was a match faced resistance from her in-laws. She finally received a kidney from an uncle, a rare occurrence in India where the vast majority of donors are women. The transplant was done only after a Government appointed committee approved it after ensuring that the donation was being done for purely altruistic reasons. Today, 3 years after her transplant, Radha, now working with a charitable organization to spread awareness about kidney disease, is expecting her first child. She is still on medications to keep her body from rejecting her kidney, but is hopeful of a leading a long and fulfilling life made possible, by an act of kindness.

Radha is one of us. She represents us. Just like her we are adept to ignoring our health. It is important that as much as we are living a fast - paced life in a technologically driven world, health must take precedence over all else.  

- Dr. Sanjeev Nair

@Nair_Sanj on Twitter

The Author is a Consultant at the Department of Nephrology at the Madras Medical Mission in Chennai.

Sunday, 3 March 2013

Why the German Economy Will Never Fail

Germany as a country has always been characterized by the outstanding work ethic of its people who are not only among the most skilled but also the most quality conscious professionals in the whole world. Its rather fashionable today and popular to predict the Euro's death and Germany's fall. It's a simple answer to a very hard question about how to integrate peoples and cultures that have been beating each other senseless for centuries. However it's even easier to predict the euro's survival backed by the German economy though much less popular.

If you spend any amount of time thinking about the ramifications of the euro going away you know that there's one reason the currency's survival is preordained: Germany.

The German economic miracle over the last decade is the direct result of the euro. The euro did away with the cost of currency conversions when importing and exporting products around the E.U. It also equalized pricing from one country to the next, and added huge efficiencies to the manufacturing and sales processes.

In essence, the euro allowed the German exports to excel.
Indeed, German exports in the early-90s rose by about 3% a year. Between 1999 and 2003, when the euro existed largely as an accounting currency only, German export growth rose by more than 6% annually. And between 2003 and 2007, when physical euro coins and notes were in circulation, German exports grew by 9% a year.

For 2011, Germany expects exports will top €1 trillion for the first time, representing more than one-third of GDP... and about 40% of that goes to other Euro-zone countries.

Anyone who thinks German business and industry - which relies heavily on selling goods to the rest of the E.U. - will allow such an important trading advantage to slip away is delusional. It's never going to happen. The single-currency's existence has added hundreds of billions of Euros to the German economy in the last few years alone.

Survival is the only option. Because consider the fate otherwise... Europe returns to individual currencies and instantly BMWs and Mercedes Benz's become too expensive across much of the rest of Europe. German exports would immediately slow and the German economy would crash. Massive layoffs would ensue and Germany's political and financial might would shrivel.

The re-emergence of Germany's former currency, the Deutsche Mark, would attract capital from all over Europe as Greeks, Italians, Irish, Spaniards, French and others dive out of their weak currencies and into a stronger currency. That would risk inflation in Germany - exactly the fear today of Germans who, as a culture, cling to images of Weimar hyperinflation.

So Germany would end up in a situation where the economy is crashing even as inflation rises.
German business and industry absolutely does not want that and it will ensure that it doesn't get it.

Vivek Sharma