Kidney cases far outstrip doctors and facilities

Medical facilities and the number of specialised doctors for treating kidney patients remain inadequate even though such patients are increasing.

This is leaving many patients without proper treatment, health experts say.

Only 35 government hospitals offer kidney dialysis at a relatively low cost, while there are just 350 specialist doctors for treating the tens of thousands of patients.

Kidney disease is called a "silent killer" because it progresses slowly and often has no noticeable symptoms until significant kidney function decline and life-threatening complications, say the experts.

Around 22.48 percent of the country's population or around 3.82 crore people suffer from kidney diseases, according to the Bangladesh Renal Association, which cites a review of eight studies published in 2019.

The association, which represents doctors treating the disease, said that 30,000 to 40,000 people suffer kidney failure every year.

Apart from state-run hospitals, private healthcare facilities also offer kidney dialysis but at significantly higher costs, placing a financial burden on patients. Most private facilities are also in towns and cities, leaving many rural patients deprived of the healthcare service.

As a result, a large number of kidney patients either do not receive proper treatment or face delays, leading to higher mortality rates.

Against this backdrop, Bangladesh, along with the rest of the world, today observes World Kidney Day with the theme, "Are Your Kidneys OK? Detect Early, Protect Kidney Health".

Katha Majumder (real name withheld) said her mother, now in her mid-50s, has been suffering from kidney disease for a long time. However, her condition worsened after contracting Covid-19 in mid-2020.

She has been undergoing dialysis since then.

After changing hospitals three times, she is now receiving dialysis twice a week at Anwar Khan Modern Medical College Hospital. The hospital charges Tk 4,500 per session, meaning that they have to spend approximately Tk 40,000 per month on dialysis alone.

She said it requires another Tk 40,000 on injections, blood, and medicine, she said. "We have to spend Tk 80,000 per month. This is a huge financial pressure."

Responding to another query, she said that they did not consider a kidney transplant due to its high cost, her mother's age, and the possible complications after the procedure.

Farhad Hasan Chowdhury, member secretary of Bangladesh Renal Association, said dialysis and kidney transplant are the only treatment available for kidney patients in the fourth and fifth stages of the disease.

However, only 35 government medical colleges and specialised hospitals currently have dialysis facilities, he said in his written speech at a press conference yesterday.

Although dialysis facilities are available at several private healthcare facilities, around 70 percent of these are concentrated in Dhaka. A very few district towns have these facilities, he mentioned.

For this, patients often have to travel to other cities with their attendants, making treatment costly and burdensome, Farhad added.

Besides, there are only 350 kidney specialists across government and private hospitals, meaning that there is just one specialist for every 5 lakh people.

In contrast, in the US, there is one kidney specialist for every 50,000 people. In India, there is one for every 3 lakh, he mentioned.

Speaking to The Daily Star, Farhad explained that there is a huge cost difference between dialysis at government and private hospitals. While government hospitals charge Tk 400 per dialysis session, the cost at private facilities ranges from Tk 3,000 to Tk 10,000.

However, dialysis facilities at government hospitals are severely inadequate, forcing many patients to seek treatment at private hospitals. But the majority can afford it for only a few months, he added.

Farhad, also an assistant professor at the Mugda Medical College and Hospital, said they can provide dialysis to only 120 patients daily.

However, around 800 patients are currently on the waiting list, and it is impossible to say when they will get the service, he added.

At the press conference, Farhad said that although kidney transplant began in 1982, the country is lagging behind its neighbours due to donor shortage.

He added that the existing capacity of the country's healthcare system can provide dialysis or kidney transplant facilities to only 15 to 20 percent of patients.

"This means around 80 percent of patients die without getting proper treatment or any treatment," he added.

PREVENTION

Prof Muhibur Rahman, head of nephrology department at Popular Medical College and Hospital, said many do not know that they have kidney diseases.

He said that there may be no symptoms until 80 percent of the kidney is damaged as the harm occurs gradually. By the time it is detected, the damage is often at an advanced stage.

"People with diabetic, hypertension, or a family history of kidney disease and those who smoke are more vulnerable to this disease," Prof Muhibur said.

Given the high costs of kidney treatment, he stressed that more emphasis should be given on prevention. He recommended that everyone undergo at least two tests -- blood (serum creatinine) and urine (albumin-to-creatinine ratio) -- for early detection of kidney disease.

Prof MA Samad, head of nephrology department at the Anwar Khan Modern Medical College and Hospital, said 10 percent of the patients are unable to afford the high cost of treatment.

Prof Muhammad Nazrul Islam, convener of Bangladesh Renal Association, said there is a severe shortage of kidney donors, as the scope for donating kidneys is limited by the law.

The association has called for an expansion of dialysis facilities to every district, increased collaboration among different doctors' organisations, and the timely promotion of kidney specialists to address these challenges.

This correspondent could not reach Prof Abu Jafor, director general of Directorate General of Health Services, for comment.

Zainal Abedin Tito, line director of Hospital Services Management, said as the number of kidney patients is rising, there should be a kidney unit at every district hospital.

The government is working on the issue, he told The Daily Star recently.

The DGHS is now implementing a project to upgrade kidney units at government medical colleges to 50-bed units and establish dialysis centres at district hospitals, DGHS source said.