Treating renal disease in India's poor: the art of the possible

The treatment of renal disease is expensive, and only a few Indians can afford it. The vast majority of Indians are poor. Nephrologists and facilities for treating renal disease are found only in larger cities. The renal unit of Apollo Hospital uses the new communications network of the country to guide patients with chronic kidney disease in increasing the dose of angiotensin converting enzyme inhibition to the maximum and thereby slow down the decline of renal function. The rate of decline of estimated glomerular filtration rate in diabetic nephropathy has decreased from 16 mL/min/y in 1993 to 2.7 mL/min/y in 2008, and in chronic glomerulonephritis from 28 to 2.8, respectively. In the entire group of patients with renal failure of all causes, the projected increase in time to reach the end stage from a glomerular filtration rate of 50 mL/min is 26 years, which is 17 years longer than the controls. Because hardly any of these patients can afford dialysis or transplantation, this is indeed an extra lease of life.