Rajeev et al. World Journal of Pharmaceutical Research
CHRONIC KIDNEY DISEASE IN EASTERN PART OF UTTAR
PRADESH – A HIDDEN EPIDEMIC AND ITS ASSOCIATED CAUSES
Dubey Rajeev Kumar1*, Singh Shivendra2, Singh R. G.3 and Singh T. B.4
*1,2,3Deptt. of Nephrology, IMS, BHU.
4
Division of Biostatic, IMS, BHU.
ABSTRACT
Non-Communicable Diseases are currently account for almost 60% of
all deaths in India. Considering the high prevalence of CKD risk
factors it has long been presumed that CKD represents a major public
health problem in our country also. This study was conducted to
determine the prevalence of risk factors of CKD and its associated
causes particularly in eastern part of U.P. This study is based on the
case recorded between 30-Aug 2010 to 30-Jun-2011 in Nephrology
OPD of S. S. Hospital, BHU, Varanasi. Analysis shows that the main
cause of CKD is Type-2 Diabetes Mellitus and Hypertension but if we talk about this
geographical region heavy metal toxicity in ground water and excess use of urea, fertilizers
and pesticides in farming is developing renal, ureteric and vesicle calculi and obstructive
uropathy causing hydro nephrosis, Urinary Tract Infection etc and other diseases which are
causing CKD in long term mostly.
KEYWORDS: uropathy causing hydro nephrosis, Urinary Tract Infection.
INTRODUCTION
In western countries, diabetes and hypertension account for over 2/3rd of the cases of CKD.[1]
In India too, diabetes and hypertension today account for 40–60% cases of CKD.[2] As per
recent Indian Council of Medical Research data, prevalence of diabetes in Indian adult
population has risen to 7.1%, and in urban population (over the age of 40 years) the
prevalence is as high as 28%.[3,4] Likewise the reported prevalence of hypertension in the
adult population today is 17% (14.8% from rural and 21.4% from urban belt). A similar
prevalence of 17.4% has been reported by Panesar et al. (in the age group of 20–59 years)
SJIF Impact Factor 6.805
Volume 5, Issue 11, 1056-1062. Research Article ISSN 2277– 7105
*Corresponding Author
Dubey Rajeev Kumar
Deptt. of Nephrology, IMS,
BHU.
Article Received on 08 Sept. 2016,
Revised on 29 Sept. 2016, Accepted on 19 Oct. 2016
even from slum-resettlement colony of Delhi.[5,6] With rising prevalence of these diseases in
India, prevalence of CKD is expected to rise, and obviously this is the key target population
to address.
But in Indian scenario over 70% of Indian population lives in villages and yet India has the
largest budget of healthcare in the world the access to government healthcare and awareness
to diseases in rural areas is much poor than urban areas.
Chronic diseases have become a major public health problem. Chronic diseases are a leading
cause of morbidity and mortality in India and other low and middle-income countries. The
chronic diseases account for 60% of all deaths worldwide. Eighty percentage of chronic
disease deaths worldwide occur in low and middle income countries.1AIn India, the projected
number of deaths due to chronic disease was around 5.21 million in 2008 and is expected to
rise to 7.63 million in 2020 (66.7% of all deaths).2A
MATERIALS AND METHODS
The study was conducted at Sir Sunder Lal Hospital, a multi-specialityhospital located in the
city of Varanasi in Uttar Pradesh, a province in North India.Patients coming here are mainly
from rural areas of Azamgarh, Ballia, Chandauli, Deoria, Ghazipur, Jaunpur, Kushinagar,
Mau, Mirzapur, SantKabir Nagar, Bhadohi, Sonbhadra, Allahabad,Varanasi etc.All patients
coming to OPD of nephrology with the symptoms of CKD are subjected to urine analysis,
hemogram, blood biochemistry(urea, creatinine, electrolytes, uric acid, calcium and
phosphorus) and ultrasound scan of the abdomen as required as per case basis. Renal biopsy
are done in selected cases with prolonged duration of acute renal failure (ARF) (>4weeks)
and unexplained ARF and in those with feature suggestive of systemic and glomerular
diseases. The diagnosisof ARF is based on standard criteria (history,physical examination,
laboratory value and clinicalcourse). Immunological assays, such as hepatitis B, surface
antigen, hepatitis C virus, antinuclear antibody, double-stranded DNA,
anti-neutrophil cytoplasmicantibody and anti-glomerular basement membrane antibody, are done
in selected cases.
Observations
A total of 2741 new cases were registered in Nephrology OPD of S.S. Hospital, BHU and
7560 old cases were seen of age group 18-80 years between 30-Aug-2010 to 30-Jun-2011.
uretary, vesicle calculi and obstructive uropathy causing hydro nephrosis and other diseases
which are undiagnosed for a long period of time due to poverty and unavailability of a good
health care system in this region as there are very small number of nephrologist or skilled
medical practitioners who can diagnose the disease and its symptom and provide the actual
health support. The main cause of these calculi and acute injuries may be heavy metal
toxicity as contamination in ground water and excess use of pesticides in farming.
According to CPCB(Central Pollution Control Board) almost 24 crore population of Uttar
Pradesh and Bihar lives in the basin of Ganga River and nearly 50% untreated and/or
partially treated sewage of these area is dumped into the river Ganga.In Uttar Pradesh
increasing trend of BOD and Faecal Coliform is observed from Garhmukteshwar to Tarighat
reflecting entire length in the state. In Bihar stretch of the river level of BOD is although
confirming to standard but increasing trend is clearly seen. Whereas, Faecal Coliform is not
confirming to standard and show increasing trend.
It is to be borne in mind that unabated discharge of treated sewage, even if after
100%treatment, with BOD level of 30 mg/l, cannot bring the water to bathing quality level
even and the desirable level of Faecal Coliform is 2500 MPN/100Ml. In Varanasi the Faecal
Coliform in year 2008 was between 11667 to 74500 MPN/100ml, whereas in Bihar it is
between 4000 to 14500 MPN/110Ml.
Some data are available on the pattern of causes of ESRD in India. Glomerulonephritides
(presumably infection-related), interstitial nephritis (thought to be due to potential
environmental exposures to nephrotoxins), and stones have been reported to be the most
frequent causes.[8,9,10] This study highlights the emergence of diabetic nephropathy as the
major cause of ESRD in India. This finding is consistent with the worldwide trend of steady
rise in the contribution of diabetes to ESRD. In a recent population-based survey, diabetes
was the cause of CKD in 41% cases.[11] Another study[12] involving several hospitals in India
found that 29% of CKD subjects had diabetic nephropathy. Variation can be encountered in
prevalence of diabetes depending upon the rural/urban divide, level of economic
development, and genetic background of the population studied. As diabetes is the main
cause of ESRD, wide variations could influence ESRD incidence. The exact cause remained
unknown in a majority of non-diabetics in this study, probably because of the delayed
incidence of diabetic renal disease compared to whites and a high frequency of patients with
advanced kidney failure of unknown etiology and small smooth kidneys.
Incidence of CKD in Eastern Part of Uttar Pradesh and nearby districts
1. The average Age of the Patients was 46.5 years (SD=14.5)
2. 90% of the population of CKD from Rural area, most of the cases (83%) was male.
3. Caste wise, nearly half of the population belonged to Other Backward caste (OBC).
4. Nearly 44% (53 patients) of the cases were suffering from either HTN or diabetes, 20%
are suffering from both diseases and rest of the 36% cases was found CKD due to other
causes.
Etiology related to CKD
Causes of CKD Percent
Both Hypertension and Diabetes 20.0%
EitherHTNorDIA 44.2%
Other 35.8%
Causes of CKD in Eastern Part of Uttar Pradesh.
The population had a mean age of 46.5 ± 14.5 years with almost 20% prevalence of both
diabetes and hypertension, 44% are suffering from either of two whereas 36 % are suffering
from other causes. It is very amazing to see that the high prevalence of CKD is from rural
setting where over 75% population had normal or low body mass index. The noticeable point
is that in 36 % cases the cause of CKD is not any chronic disease (diabetes or hypertension or
both) but it may be calculi and other infections and surprisingly to see the rising prevalence
of hypertension in rural belts. Possibly with shifting population the difference between urban
and rural areas is getting blurred. Undoubtedly, we need more Indian data to validate these
findings.
DISCUSSION
CKD is a problem of epidemic proportion in India with increasing diabetes burden,
hypertension and growing elderly population and it may further increase. In this study we
have seen that major percentage of CKD patient coming to OPD of S. S. Hospital belong to
the rural part of eastern Uttar Pradesh. During study of major causes of CKD in the eastern
part of UP except diabetes and hypertension one of them is water pollution. Most part of this
region are situated on the bank of river Ganga, water here contaminates with heavy metal
toxicity according to CPCB (Central Pollution Control Board, Govt. Of India) like arsenic,
cadmium, fluoride and other pesticides which are coming from untreated sewer water and
factories water and the increasing use of urea, fertilizers and other pesticides. In other reason
aware that they are harboring the disease, and the major cause of this is low economic status
and poor education level of this region, therefore if we target the high risk population than
half the patients are likely to be missed because accurate estimation of burden of CKD is not
possible at present due to lack of comprehensive CKD registry. The Indian CKD registry is
purely voluntary and captures only a very small proportion of CKD reaching nephrologists in
India.
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