1.

INTRODUCTION
The Kidneys are key to health! ... take care for yours!!

Ever year March 10 is celebrated as World Kidney Day. This year with a logo of Protect your kidney to save your heart was the message given by medicos on World Kidney Day. Recent studies have proved a link between heart and kidney ailments, two of the most prevalent diseases resulting from modern lifestyle.1

The word 'renal' has a Latin origin and means "kidney-related". The term "failure", means "not functioning optimally or fully". When kidney function is impaired this is described as renal failure .Renal (kidney) failure is classified as either acute or chronic. In 24 hours, your kidneys filter around 150 litres of blood and produce roughly 1.5 litres of urine.2

The kidney disease outcomes quality initiative of the national kidney foundation defines chronic kidney disease as either kidney damage or a decreased kidney glomeular filtration rate less than 60ml /min/1.73m2 for 3 or more months. Factors affect to chronic renal failure are Diabetes type I and 2, Hypertension, Cardiovascular disease, Age greater than 55 years, obesity family history of ESRD. According to NHANES III, the distribution of estimated glomerular filtration rate for the chronic disease stages was similar in both sexes.3

Chronic kidney disease is found in persons of all ages. The biologic process of aging initials various structural and functional changes with the kidney. Renal mass progressively declines with advancing age. Glomerulosclerosis leads to a decrease in renal weight. Histologic examination is not able for a decrease in glomerular number of as much as 30-50% by the age of 70 years.4

There has been a remarkable increase in the incidence of kidney disease in the last decade. WHO estimates that CKD is the 12th leading cause of death and 17th cause of disability due to high occurrence of diabetes, hypertension, lack of physical exercise, use of drugs toxic to the kidney are possible causes for the true rise.5

As India, is the diabetes capital of the world, experts in India say nearly 40 percent of diabetics can be affected by chronic kidney disorders. Around 1.5 lakh (150,000) new cases of kidney failure are diagnosed annually in India. The International Diabetes Foundation has reported approximately 54 million diabetic patients in India in 2010, and the number is likely to touch 70 million by the year 2025. Nearly 150,000 new cases of kidney failure come up annually in the country.6

Chronic kidney disease

is a worldwide public health problem and is now

recognized as a common condition that is associated with an increased risk of cardiovascular disease and chronic renal failure. Chronic kidney disease is a national public health problem beset by inequities in incidence, prevalence, and complications across gender, race/ethnicity, and socioeconomic status.7
2

Chronic kidney disease is an international medical problem that doesnt differentiate between social and economic borders. It is particularly cruel in developing countries, such as Africa and India, where delayed diagnosis, lack of preventative measures, shortage of nephrologists and lack of funds have created high risk for the to a death sentence for many patients diagnosed with end-stage renal disease (ESRD).8

Good nutrition means getting enough macronutrients and micronutrients. Macronutrients contain calories (energy): proteins, carbohydrates, and fats. They help you maintain your body weight. Micronutrients include vitamins and minerals. They keep your cells working properly, but will not prevent weight loss. Ben Franklins quote of an ounce of prevention is worth a pound of cure rings especially true in developing countries.9

A renal diet means a diet prescribed in chronic renal failure and designed to control intake of protein, potassium, sodium, phosphorus, and fluids, depending on individual conditions. Carbohydrates and fats are the principal sources of energy.10

Worldwide, the number of qualified health professionals available to manage patients with CKD is increasing, however as per capital income grows within a country, treatment rates for ESRD increase. In countries with the lowest per capita income, there is the lowest rate of treated kidney failure.11

The topic of "kidney Health" is becoming increasingly important, given the rising incidences of kidney problems. Until recently, very few people were concerned about this topic. Almost everyone is familiar with heart disease, cancer, stroke, diabetes, and high blood pressure. While these are probably the leading causes of health problems and death, not many people realize that kidney disorders can lead to many of these degenerative diseases.12

The kidney is such an important organ, yet most people have little idea about its crucial role in the body. Consequently, we unknowingly distress this vital organ, mainly through poor lifestyle habits and choices. The world kidney day would succeed if all of us are aware of the importance of our kidneys an amazing organs that play a crucial role in keeping us alive and well and to spread the message that kidney diseases is common harmful and treatable. 13

NEED FOR THE STUDY Diet cures more than the doctor Chronic Kidney disease is a world wide public health problem in April 2007 and is now recognized as a common condition that is associated with an increased risk of cardiovascular disease and chronic renal failure. Globally, kidney disease is the third biggest killer after cancer and cardiac ailments. More than 200,000 kidney failures occur in India annually. In six out of 10 chronic kidney disease patients, diabetes and hypertension are the underlying cause. Kidney disease has indeed assumed worrisome proportions in India.14
4

According to the World Health Organization (WHO) Global Burden of Disease Project, diseases of the kidney and urinary tract contribute to approximately 850,000 deaths every year and 115 million disability adjusted life years. The lack of national registries, such as those in developed countries, makes it difficult to obtain accurate statistics regarding chronic kidney disease.15

In The United Kingdom The Annual Incidence Of End Stage Renal Disease Is Around 100 Per 1,000,000 Populations. This Figure Has Doubled Over Past Decade And Is Expected To Continue To Rise By 5.8% Annually, But It Still Remain Well Below The European Average Around 135/1,000,000 And That Of The United States (336/ 1,000,000).16

The rise in end stage renal disease world wide probably reflects and global epidemic of type 2 diabetes and the ageing of the population in developed countries (The Annual Incidence In People In Over 65 In The Uk Is Greater Than 350/1,000,000 And In The Us It Is Greater Than 1,200/1,000,000. The Geriatric Population is the most rapidly growing kidney failure population in the united states.17

According to the report given by American Society of Nephrology in 2008, which list top 5 countries in the world with annual deaths rates due to renal failure are United state- 14,482 deaths, Japan 8,688 deaths, Mexico- 6,330 deaths, Egypt- 5,193 deaths & Germany-4,417 deaths.18
5

According to the survey report given by WHO, the renal disease in southern Asia are : Afghanistan 7,75,739, Bangladesh 3,45,292, Bhutan 5,90,460,India 2,97,185,

Pakistan 4,31,076 & Sri Lanka 5,41,537 .19

In India chronic renal failure is the major leading cause of death. Every year 100/million/ population / years affected and it can lead dead twice by next two years. In terms of numbers, the National Kidney Foundation (India) estimates approximately 200,000 people in India go into terminal kidney failure annually and millions more suffer lesser forms of kidney disease. 20

According to the study conducted on prevalence of the chronic renal failure and adults in Delhi India in September 2005. A total of 4972 subjects were contacted during the 3 years of he study. The mean age of all the participants was 42.38#12.54 years and 56.16% were male. The prevalence of chronic Renal failure in adult in India was 37/4712 or 7852/million.21

A study was conducted to know about the economic facts and the problems dealing with chronic renal failure in India as compared to a developed country like the U.S. India has a population of 1.1. billion and its growing. The per capita annual income is about $530 and about 30% of the population lives on less than #110 per year. It cost anywhere between $4,440 and $ 8,880 per year for any kind of renal replacement therapy and for most patients the cost is met through charity, family, friends and philanthropic organizations. 22
6

According to prevalence of early stages of chronic renal failure are apparently healthy central government employees in India a cross sectional study of Indian central government employees over 18 years of age was carried out. 66.04% males and 33.96% females were studied. The result of the study revealed that the healthy adult Indian central government employees 15.04% males and 13.12% were females to have early stages of chronic kidney disease.23

A report was published in Times of India on world kidney day stating that around two lakhs of people in the country reach end stage renal failure. If the government had to make a budget for kidney disease alone, it would have been around Rs 32,000 crore to Rs 40,000 crores given the high costs of transplantation and dialysis. Indians can keep kidneys healthy at Rs 32cr.24 According to the report given by the J J Hospital on 9/3/2011 in south Mumbai, about 2,500 patients registered with a kidney disease which is more than four times the figure five years ago. The burden of the disease seems the highest in Mumbai because its registrations in comparison to Chennai and Hyderabad is higher has they take registrations for their entire states.25

According to the hospital report of Bangalore kidney foundation, about 200,000 people added each year in India to the growing lists of patients. The estimated annual expenditure for a patient on dialysis is about Rs.200, 000. About 10,000 dialysis is

estimated shortage per month in metros due to insufficient number of dialysis centers & high cost of dialysis.26

As the report given by the national kidney foundation, the cost of kidney failure is very high in India. The cost of getting haemodialysis (12 dialysis / month) is around Rs. 12-15,000/- per month whereas for peritoneal dialysis it is around Rs. 18-20,000/-per month .Getting a transplant done costs around Rs. 4 lakhs on an average. After that the per month recurring costs may vary from Rs. 5,000/- to Rs. 10,000/. This is the most important reason why only 2-3% of kidney failure patients in India get treated.27 Around 10,000 people in Karnataka develop kidney failure every year. And one in ten people in India suffers from some form of mild kidney disease. The exorbitant cost of treatment makes the situation worse for kidney patients, despite 80 percent of Karnatakas nephrologists are in Bangalore. 28

Although chronic kidney disease has silently afflicted a large number of Indians, a strictly regimented diet and lifestyle can ease the disease burden. Based on the above mentioned studies and findings the researcher found that there is a lack of knowledge on renal diet among chronic renal failure patients. As a result, the researcher felt that it is necessary to educate and create awareness among CRF on renal diet to reduce mortality and morbidity rate.