10% of the global population suffers from chronic kidney disease (CKD), with millions dying annually due to unaffordable treatment. CKD ranks among the top causes of worldwide mortality, with rising deaths over the past two decades. Enhanced prevention and treatment efforts are crucial. According to Lancet, CKD is prevalent across regions, with 59% of cases in low- and middle-income countries (LMICs). Factors contributing to high CKD prevalence in India include nutritional deficiencies during pregnancy, genetic predispositions, environmental pollutants, and increasing rates of diabetes and hypertension. By 2030, India is projected to have the highest diabetic population globally – which will invariably also increase the occurrence of CKD. Yet awareness about kidney health remains low. Many turn to alternative medicines, despite potential harm. Dr. Shyam Bansal, Head of Nephrology at Medanta, discusses why people seek alternative therapies for kidney ailments and best practices for kidney health.

Q. What are the early signs of kidney damage?

A. So, kidney disease sometimes presents with no signs or symptoms until the very end. However, some patients might experience swelling in their feet or body, reduced appetite, and nausea. These are some of the early signs, but one should not wait for these signs to develop. If someone is at high risk for kidney disease—such as people with diabetes, hypertension, a family history of kidney disease, or obesity—they are in the high-risk group. They should undergo routine check-ups to detect kidney disease in its early stages.

Q. Could you discuss the trends observed in kidney diseases lately, especially considering the rising burden of non-communicable diseases (NCDs) and changes in people’s lifestyles?

A. It’s important to understand that diabetes and hypertension are the two leading causes of kidney disease. In India, for instance, about 10% of the population has diabetes, and 25 to 30% have hypertension. Consequently, 40% of kidney disease patients have diabetes. Lifestyle-related factors often contribute to diabetes and hypertension, which typically lead to kidney disease later in life. However, there are other causes of kidney disease, such as glomerulonephritis, an immune-mediated condition that damages the kidneys’ filters and can lead to protein in the urine. This can occur very early in life, and we see many patients in their 20s and 30s. Additionally, some genetic diseases cause kidney issues in children, leading to the need for dialysis or a kidney transplant by the age of 10 or 15. Kidney disease can affect individuals of all ages, depending on the cause, whether it be genetic factors, certain medications, toxins, untreated stones, obstructions like prostate issues, or malignancies. The spectrum of kidney diseases is vast, but it can impact anyone at any age. Lifestyle diseases such as diabetes and hypertension are significant contributors and are leading to an increase in kidney disease. Kidney disease has now become the seventh leading cause of death worldwide, up from 12th and 13th, and is projected to become the fifth leading cause within the next decade or so.

Q. How to best manage kidney stones?

A. Kidney stones are indeed common. Approximately 5 to 10 percent of people might develop kidney stones over their lifetime. The likelihood depends on various factors, including where you live, your diet, and other lifestyle choices. Kidney stones can also result from genetic conditions that predispose individuals to recurrent stone formation, as well as metabolic risk factors such as diabetes, obesity, and inadequate hydration. It’s crucial to understand that large kidney stones, typically more than 8 or 9 mm, are unlikely to pass through the urinary system naturally. The ureter, the tube that connects the kidney to the bladder, is usually about 6 to 7 mm in diameter. Therefore, a stone larger than this is unlikely to pass on its own and, if left untreated, can cause long-term damage to the kidney. This is a significant contributor to various kidney issues.

Sometimes, individuals might opt for alternative therapies, hoping these treatments will dissolve the stones. Unfortunately, these methods are often ineffective, especially for large stones. While small stones may pass spontaneously, larger stones do not and require medical intervention to prevent kidney damage. If you have a kidney stone that is not passing on its own, it’s important to seek medical treatment to protect your kidney health.

Q. Why do you think patients with kidney ailments are seeking out alternative therapies?

A. One reason might be a perceived shortfall within the medical system. As allopathic doctors, perhaps we haven’t built enough trust in the scientific basis and research-backed effectiveness of allopathic treatments. People might be looking for easier solutions.

In India, for example, there’s a traditional belief in the inherent safety and efficacy of natural or alternative treatments like Ayurveda or homeopathy, under the assumption that they have fewer side effects. However, this isn’t always the case.

Some people might want to avoid what they perceive as unnecessary medical procedures, influenced by the abundance of advertisements for alternative medicines. Without proper research or skepticism, individuals might be swayed by these advertisements, believing in their efficacy due to repeated exposure.

Unfortunately, when these alternative therapies fail to resolve their issues, people often end up in the hospital in more severe conditions, incurring higher costs without significant health improvements.

A scientific mindset is crucial, regardless of the treatment approach—allopathic, Ayurvedic, or otherwise. Patients should inquire about the rationale, benefits, risks, and necessity of any treatment. For instance, a relative of mine experienced acute coronary syndrome but was initially reluctant to follow a cardiologist’s advice. It took considerable persuasion for her to undergo necessary procedures like angiography and angioplasty, which ultimately proved to be life-saving.

The tendency to reject modern medical advice in favor of traditional treatments might stem from a lack of understanding. Modern medicine, with its lab tests and evidence-based practices, has developed significantly over the past 200 years, continually adapting based on new research. Applying ancient practices without considering the context of modern diagnoses can be problematic.

Encouraging more science-oriented questioning and fostering a deeper understanding of medical science could help bridge this gap, steering people away from seemingly easy but ineffective treatments.

Q. You’ve correctly noted our cultural tendency to believe that anything natural is beneficial for our bodies, leading to significant reluctance toward embracing modern scientific methods. But do you think the rising out-of-pocket expenses can also be a cause for seeking alternative treatment, which might be comparatively cheaper?

A. Regarding healthcare costs, it’s essential to recognize the variety of available options. One doesn’t always need to visit a corporate hospital, which tends to be more expensive due to its infrastructure, staff, and maintenance costs.

For instance, during my student days, my brother needed treatment for a medical condition, and we opted for AIIMS, which involved lengthy waits but was more affordable. Besides corporate hospitals, there are trust hospitals, charitable institutions, government hospitals, and clinics that offer services at reduced rates.

As for the cost of alternative treatments, it’s a misconception that they are invariably cheaper. I’ve encountered patients who pursued Ayurvedic treatments, spending significantly more than they would have on conventional medicine. One patient with type 1 diabetes was misled into believing he could be cured without insulin and ended up paying 5000 rupees per day for treatments that ultimately failed, forcing him to return to conventional hospital care with worsened conditions.

Similarly, I’ve seen patients with kidney disease who spent upwards of 20,000 rupees per month on Ayurvedic treatments when conventional medication would have cost them a fraction of that. The expense of alternative therapies can surpass that of allopathic treatment, lacking the efficacy and safety backed by scientific research.

When discussing costs, it’s also worth comparing healthcare expenses with other services, such as private schooling or legal consultations, which can also be quite high. The key is to value the expertise and quality of care, understanding that effective treatment is an investment in one’s health.

Q. What are your thoughts on the government’s support for AYUSH?

A. I prefer not to comment on that specific topic, as it’s quite distinct. However, my advice to people would be to maintain a healthy skepticism. Don’t take everything you hear at face value; it’s crucial to ask for evidence and question the claims being made. People can be very persuasive, employing various strategies to attract patients. Yet, when serious complications arise—imagine sudden chest pain or breathing difficulties—the question becomes: where will you seek treatment? That’s an important consideration.

Q. Do you believe it’s also the government’s responsibility to provide guidance regarding AYUSH, particularly because they promote it?

A. My stance is not against alternative therapies per se, but I advocate for evidence-based treatments. In the past, allopathy too had limited treatments available, but with advancements in science and research, we’ve made significant progress. Today, we can perform kidney transplants, bypass surgeries, and a host of other medical procedures across various fields. It’s not about distinguishing between acute and chronic diseases; both can be addressed with allopathic medicine based on solid evidence. We’re aware of our limitations and communicate what is possible and what isn’t to our patients. Science is continually evolving; what may not be possible today could become feasible tomorrow.

Therefore, my main point is the need to foster health literacy and a scientific mindset among the public. Unfortunately, this is lacking, as people often take information from social media, television, or print media at face value without questioning its validity. We should strive to create an environment where health awareness is widespread, and treatments are chosen based on scientific evidence rather than hearsay.

Q. I’ve come across a few reports suggesting that the keto diet, which is quite popular among some health influencers and celebrities, can lead to kidney damage. Is that true?

A. For individuals with normal kidney function, consuming a higher protein diet typically doesn’t pose a problem. However, if kidney function is already compromised, a high-protein diet could accelerate the deterioration of kidney function. Many people consume a high-protein diet without experiencing kidney damage. Yet, if someone has an undiagnosed condition and adopts a very high-protein diet, it could potentially exacerbate kidney disease. That said, I’m not a diet expert, so I can’t specifically comment on the keto diet’s safety. Generally, it’s advisable for anyone considering a high-protein diet to monitor their kidney function, as they might be unaware of a pre-existing mild kidney issue.

Q. Could you share some tips on how people can take care of their kidneys to avoid issues, setting aside genetic vulnerabilities? What are some good practices?

A. As mentioned earlier, diabetes and hypertension are significant risk factors for developing kidney disease. It’s crucial to manage your diabetes from the onset and not wait for complications to arise. Uncontrolled blood sugar and blood pressure over many years can lead to various chronic diseases, including kidney disease, heart disease, and stroke, accounting for 70-80% of such conditions.

Regarding other issues like kidney stones, if you have a large stone that cannot pass on its own, it’s important to have it professionally removed. Consult a qualified urologist for this matter. Additionally, one should be cautious with the use of non-steroidal anti-inflammatory drugs (NSAIDs), as certain painkillers can harm your kidneys.

It’s also advisable to avoid medications containing heavy metals, which are sometimes found in alternative medicines, particularly some Ayurvedic treatments, as they are known to cause kidney damage.

For those with a family history of kidney disease, regular check-ups are essential to determine your risk and manage it accordingly. And for genetic conditions, it’s even more important to have routine screenings.