Getting around kidney failure

Getting around kidney failure

With limited dialysis machines and donors, Bhutanese should be proactive to avoid this lifestyle disease

18 March, 2009 - “Doctor, how long can I live on dialysis?” asked a patient undergoing hemodialysis, an artificial process that replaces the kidney’s functions, at the Jigme Dorji Wangchuck national referral hospital (JDWNRH) dialysis unit. “I’ve seen patients live up to 5 years,” answered the doctor.

Fortunately, for the patient, he may not have to find out. He is one of the lucky few, who have willing kidney donors identified and matched by the hospital. For the others, they await their weekly turn at the dialyser, their artificial kidney, until a donor of their match in blood type comes forth.

The number of kidney or renal failure cases in Bhutan is increasing, said the medical specialist at JDWNRH, Dr Tek Bahudur Rai. At present, there are forty-five patients taking turns undergoing hemodialysis at JDWNRH. A significant increase from only 8 patients in 1998, when the dialysis unit was first opened. Despite this increase in patients, the hospital has been equipped with only four dialysis machines since then, a number not sufficient for the increasing number of patients, according to staff nurse, Savatri.

“Patients should receive dialysis at least three times a week but, because we’ve too many patients, they receive it only once a week,” she said. Each dialysis procedure lasts four hours and only eight patients are able to receive treatment in a day.

Renal failure occurs when the kidneys fail to remove excess fluid, minerals and other waste from the body at an adequate rate. There are two types of failure: acute and chronic renal failure. Acute renal failure is a more rapid type, caused by damage to the kidneys. Over-use of antibiotics and aspirin, use of diuretics, loss of blood due to injury or vomiting, loss of fluids due to diarrhoea can be some of the causes. If treated promptly, it is reversible, say doctors.

Chronic renal failure, on the other hand, is irreversible. It is caused by infection, diabetes and high blood pressure or hypertension. The only treatments available are dialysis and kidney transplantation. With only four dialysis machines and a severe shortage of kidney donors in the country, Dr Rai believes Bhutanese need to take preventive measures.

Dr Rai said a change in lifestyle from a physically active to sedentary was one of the reasons for the increase in kidney problems. He said more Bhutanese were becoming less physically active and, combined with a rich diet, it predisposed individuals to acquiring non-communicable diseases, such as hypertension, diabetes and cancer, three of the main causes of renal failure in Bhutan. He advised people avoid these diseases by simply being more active. “A brisk walk, where you break a sweat, would be enough,” he said.

He also said Bhutanese needed to be more careful with their diet. He suggested consuming less or moderating intake of alcohol, tobacco, fat, and salt. He pointed out that Bhutanese were copious consumers of salt. Too much salt can cause hypertension, which can then contribute to renal failure.

JDWNRH dietician, Shanthi Mathew, said that, since the Bhutanese lifestyle was changing, the diet also had to change. Bhutanese should improve their diet by reducing the amount of carbohydrate-rich food (white rice, white bread, and other processed foods), while eating more fibre-rich food such as leafy vegetables and fruits, she said. She also concurred that physical activity was very important in avoiding non-communicable diseases that could lead to renal failure.

Meanwhile, two chronic renal failure patients have died this month. Dr Rai said more dialysis units had to be opened in other districts like Mongar and Gelephu, where the facilities were available but there were no trained staff.

By Gyalsten K Dorji

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