Renal failure deaths and their risk factors in India 2001–13
Authors: Pramod K Guru, Sitanshu Sekhar Kar
Journal: The Lancet Global Health (2017)

Anna J Dare and colleagues (January, 2017)1Dare AJ Fu SH Patra J Rodriguez PS Thakur JS Jha P Renal failure deaths and their risk factors in India 2001–13: nationally representative estimates from the Million Death Study.Lancet Glob Health. 2017; 5: e89-e95Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar report renal failure deaths and their risk factors from two nationally representative mortality surveys among people aged 15–69 years in India for 2001–03 and 2010–13 as a part of the Million Death Study. We congratulate Dare and colleagues for bringing the very important public health issue of renal failure deaths, which is usually an unnoticed issue, to the forefront. We have some comments to offer. First, Dare and colleagues focused on renal failure deaths as defined by the ICD-10 codes N00–N19 and we wonder why the other categories (such as N25–N29) were excluded from the analysis. Whether Dare and colleagues were focusing on only avoidable causes or the complete range of renal failure deaths should have been reflected in the title of the Article. Second, it was not clear whether the coding for the conditions considered during 2001–03 and 2010–13 remained consistent. Third, we believe the study findings have a lot of implications for Indian policy makers. India has started a non-communicable disease (NCD) prevention programme (the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke; NPCDCS) since 2010. As of March, 2016, the programme is under implementation in all 36 states and union territories of India, covering 298 district NCD cells, and 293 district NCD clinics have been established. In 2016, prevention and management of chronic obstructive pulmonary disease and chronic kidney disease (CKD) have been included in the programme.2Ministry of Health & Family WelfareNational Programme For Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS).http://mohfw.nic.in/index1.php?lang=1&level=3&sublinkid=3627&lid=2194Google Scholar Although the inclusion of CKD is a welcome step, clear guidelines on prevention, management, and continuity of care should be formulated at the state or regional level to meet the emerging challenges. The study findings could be used to prioritise and align the programme objectives. The target groups for prevention should be people aged between 15 and 40 years (since the median age of people who died because of renal failure was 55 years; IQR 42–63), male (64% deaths were in men), residing in urban areas (these areas had higher age-standardised mortality than did rural areas), and residing in the southern and eastern states of India, where the mortality due to renal failure was the highest.1Dare AJ Fu SH Patra J Rodriguez PS Thakur JS Jha P Renal failure deaths and their risk factors in India 2001–13: nationally representative estimates from the Million Death Study.Lancet Glob Health. 2017; 5: e89-e95Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Although CKD is emerging as a major global health problem, the elusive test to diagnose it early is non-existent. In addition to the established risk factors such as diabetes, hypertension, and cardiovascular disease, the research and epidemiological studies over the past decade have defined the role of acute kidney injury as the major cause of CKD. Unfortunately, like CKD, the diagnosis and management of acute kidney injury remains an enigma for the medical fraternity. Given the differences in causes, health care, and outcomes between acute kidney injury and CKD, it is essential to differentiate the two disorders from a public health perspective. The current study is not able to put any lights on this important topic, as mentioned by Vivekanand Jha and Gopesh Modi in their linked Comment.3Jha V Modi G Uncovering the rising kidney failure deaths in India.Lancet Glob Health. 2017; 5: e14-e15Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar It is also imperative to establish and improve access to renal replacement therapy (dialysis and kidney transplantation) in high-risk areas, but focusing on primary prevention will be a more cost effective strategy for a society with limited resources, such as India. We declare no competing interests. Renal failure deaths and their risk factors in India 2001–13: nationally representative estimates from the Million Death StudyRenal failure is a growing cause of premature death in India. Poorly treated diabetes is the most probable reason for this increase. Strategies aimed at diabetes prevention, and early detection and treatment are urgently needed in India, as well as greater access to renal replacement therapy. Full-Text PDF Open AccessRenal failure deaths and their risk factors in India 2001–13 – Authors' replyOur Million Death Study data indicate that, between 2001 and 2013, mortality rates from renal failure increased significantly in India, especially in the 45–69 year age group (figure), and in the southern and eastern states. For each death, two of 400 trained physicians independently and anonymously examined field records, consisting of checklist questions and a half-page narrative in local language, following strict and consistent guidelines for coding renal failure and other deaths.1 The ICD-10 codes to define renal failure did not include calculi-related conditions, which may lead to urosepsis, or "other" genitourinary system deaths which are non-specific. Full-Text PDF Open Access