(Interview with Dr. M.K. Mani, Senior Consultant Nephrologist, India)

Dr. M.K. Mani, Chief Nephrologist, Apollo Hospital, Chennai, India, and Managing Trustee of Kidney Help Trust, Chennai, India, has proved to the world that it is possible to prevent chronic renal failure at a community level with a very limited budget. True to the maxim, “The smallest good deed is better than the grandest good intention,” the rural program of the Kidney Help Trust envisioned by Dr. M.K. Mani has been instrumental in preventing around 60% of chronic renal failure in a small rural community in Sriperumbudur Taluk, about 50 kms from Chennai.

Medindia Spoke to Dr.M.K.Mani and heard from him the dynamics of the Project that helps poor people keep a check on their health condition—mainly diabetes, hypertension and kidney diseases.

Q: Doctor, at the outset could you share with us the major highlights of your Kidney Help Trust—particularly the program aimed at preventing chronic kidney disease (CKD) among the rural poor?

A: • Around 60% of chronic renal failure has been prevented in a target population of 21,000 people from the lower economic strata in a rural area in India. The area adjacent has 28 patients with chronic renal failure per 1000 population, but in the area we have covered it is only 11 per 1000 of the population

• 96% of hypertensives had their blood pressure well controlled through this project

• Glycated hemoglobin (HbA1c)- was down to 7% or less (indicating near perfect control) in 52% of the diabetics and a further 25% had the level brought down by 10% of the original reading. Major American and British studies had demonstrated that a 10% reduction of glycated hemoglobin meant 40% fewer patients with vascular complications like heart attacks, strokes and renal failure.



Doctor Examining a Patient Under a Tree


Doctor Seeing a Patient in his House

• People were treated for diabetes and hypertension with the cheapest available drugs, which are among the most effective, though they have gone out of vogue

• Most of these people are on daily wages, and cannot afford to go to a Primary Health Centre, spend a few hours in a queue, and receive a week’s supply of medicines. They would lose a day’s wage, and will only go to the PHC if they are prevented from working by a severe pain or a high fever. They will never take treatment from the PHC for diseases that need life long treatment

• Our statistics prove we can establish good control of hypertension and reasonable control of diabetes in the community, thereby preventing vascular complications at least in some patients

• Though there are domiciliary programs in India for leprosy and tuberculosis, Kidney Help Trust’s simple method of going to the person’s home to detect and administer treatment over a period of time is the first of its kind in India for a non-communicable disease

Q: Before we go into the details of your rural campaign to promote overall better health and to prevent chronic kidney diseases in particular, please trace the connection between diabetes, hypertension and kidney diseases?

A: The kidneys play a vital role in purifying blood and regulating important body functions such as blood pressure, formation of red blood cells (RBCs) and the formation and maintenance of healthy bones, among other things.

The kidneys receive 25% of the body’s blood supply pumped by the heart. Consequently, a huge quantity of harmful substances carried by the blood reach the kidneys. Diseases that damage the blood vessels—diabetes and blood pressure mainly, affect the kidneys since they are full of blood vessels. When the kidneys fail, toxins accumulate in the blood. The patient gradually dies a painful and miserable death following a rise in blood pressure, severe anemia, weakness, brittle bones and other complications.

Q: What are the treatment options for kidney in India?

A: India has excellent nephrologists and urologists and numerous hospitals spread across the country in urban and some suburban areas with facilities to treat end stage renal disease (ESRD). On the downside, the cost of treating kidney diseases, though cheaper than in most other countries, is too high for the vast majority of Indians. It would cost close to Rs. 400,000 ($8114) for the least expensive form of treatment, transplantation, and an annual maintenance cost of close to Rs. 100,000 ($2028). How many Indians do you think can afford that sum?

Anyone who is familiar with the hard economic facts of India will clearly understand that the treatment of established end stage renal disease is a pipe dream for the average Indian.

Q: How exactly did your project for the prevention of chronic renal failure in a rural community take shape?

A: The Kidney Help Trust (registered with the Government of India and cleared to receive contributions from abroad) was started in 1985 by a group of 5 doctors and 2 philanthropists, who had renal patients in their family, aiming to raise funds to help patients to pay for transplantation. Two years later we realized that our accumulated funds would pay for only 15 transplants. It seemed unfair that only a fortunate few benefited from our exercise, while hundreds of thousands died from renal failure for want of money.

The Kidney Help Trust decided to change track and use its limited funds to benefit a larger number of people with kidney disease. We understood that where resources are minimal and problems are colossal, we need to provide the greatest good for the greatest number at the least expense. The focus was changed to prevent chronic renal disease at a very low cost by early detection and treatment of hypertension, diabetes (the major causes of kidney failure) and other kidney diseases.

Q: How did you go about translating your plan into action?

A: Diabetes and hypertension are widely prevalent in India. Our plan was simple. We would identify all diabetics and hypertensives early, by an annual survey of the entire population, and control their blood pressure and blood glucose with the cheapest methods. If diabetes and hypertension are well controlled, the blood vessels will not be affected, and we should prevent damage to the kidneys. While that was not our original aim, we have some evidence that we might have reduced the incidence of strokes and heart attacks too.