Kidneys and the Climate A Two-Way Crisis India Cannot Ignore
It is high time that India must confront a sobering reality that is rarely discussed outside medical circles: climate change and kidney disease are tightly linked and each is making the other worse.
Rising temperatures increase dehydration which raises the risk of kidney stones, electrolyte imbalance and cause kidney injury. Air pollution and environmental toxins can damage kidneys as early as in the womb of the mother. Children suffer the most as exposure to polluted air has been linked to increased likelihood of pre-term and low birth weight babies. These children can develop hypertension as they may be born with low number of kidney filter units called nephrons.
The kidney cannot regenerate these units and a child born into a polluted environment starts a life with compromised kidney reserve. Burgeoning metropolises like Delhi, Mumbai, Pune are suffering from poor air quality, concrete avalanche and replacement of natural soil with impervious surfaces causing water logging in monsoon. This paves a path for climate related infections like Dengue, Leptospirosis, diarrhoea related diseases which further increase kidney injury risk. Lack of greenspace is associated with limited physical activity and obesity in youth which quietly increase the long-term burden of chronic kidney disease.
THE PARADOX: THE FOOTPRINT OF KIDNEY CARE.
While we focus on treating kidney disease with lifesaving treatments like dialysis, we must keep in mind that they bear a massive environment cost. A single hemodialysis session can discard upto 500 liters of water. The dialysis unit has high electric consumption and produces vast amounts of plastic waste, much of which is diverted to infectious waste streams. Patients must travel multiple times in a week to the hospital for hemodialysis treatment and the travel adds to carbon emissions and financial burden.
THE INDIAN REALITY:
Many patients in India present late in advanced stage of kidney disease due to lack of awareness on symptoms of kidney disease coupled with cost of health care. This further makes care more intensive and costly. Some hospitals may face water shortages, power-cuts and have limited waste-management systems. Further, our kidney transplant rates remain low and patients remain on long term dialysis. This forced longevity on dialysis creates a massive carbon footprint. A patient waiting 10 years on dialysis for a kidney will generate 5,000 kg of plastic waste and consume 1.5 million liters of water.
SOLUTIONS:
India must expand kidney care access while making hospitals climate-conscious. Doctors, administrators, policymakers, and citizens all have roles to play.
THE BIGGEST SOLUTION: PREVENTION
This warrants screening for signs of early kidney disease with simpler and cheaper tests like blood test for creatinine, urine test for protein leak and blood pressure check. In children, growth failure, bony deformities and high blood pressure could be the tell tale signs of underlying kidney disease. It is imperative to create public awareness on climate change, hydration and heat safety. Early detection of diabetes, hypertension and obesity prevention is must.
The local government can incentivize hospitals to set up effluent treatment plants for dialysis units. It can create a water credit system where hospitals that use reclaimed water for campus greening receive a tax rebate on their municipal water tax. Other measures could be : set up recycling centers for noninfectious clean medical plastics in the hospitals; provide a subsidy for installing solar panels on the rooftops of hospitals to power dialysis and ICU units. It should be mandatory to protect the green cover of the city, provide cleaner air and safer water.
By transitioning a patient from dialysis to transplant, we can stop production of dialysis specific waste like dialyzers, blood lines, saline bags. We can eliminate the high electricity demand required to run the dialysis machines and water treatment plant.
A stable transplant patient may need fewer clinic visits drastically cutting the carbon footprint of transport. Promoting cadaveric organ donation is a quest for sustainability. Every donor who provides two kidneys can potentially save two lives and decommission 2 dialysis slots. It is the need of the hour that all ICU units should try to report potential brain-dead donors to a central registry and promote cadaveric organ donation.
If the planet’s health fails, kidney health will suffer. Sustainable kidney care is the need of the hour.
Rising temperatures increase dehydration which raises the risk of kidney stones, electrolyte imbalance and cause kidney injury. Air pollution and environmental toxins can damage kidneys as early as in the womb of the mother. Children suffer the most as exposure to polluted air has been linked to increased likelihood of pre-term and low birth weight babies. These children can develop hypertension as they may be born with low number of kidney filter units called nephrons.
The kidney cannot regenerate these units and a child born into a polluted environment starts a life with compromised kidney reserve. Burgeoning metropolises like Delhi, Mumbai, Pune are suffering from poor air quality, concrete avalanche and replacement of natural soil with impervious surfaces causing water logging in monsoon. This paves a path for climate related infections like Dengue, Leptospirosis, diarrhoea related diseases which further increase kidney injury risk. Lack of greenspace is associated with limited physical activity and obesity in youth which quietly increase the long-term burden of chronic kidney disease.
THE PARADOX: THE FOOTPRINT OF KIDNEY CARE.
While we focus on treating kidney disease with lifesaving treatments like dialysis, we must keep in mind that they bear a massive environment cost. A single hemodialysis session can discard upto 500 liters of water. The dialysis unit has high electric consumption and produces vast amounts of plastic waste, much of which is diverted to infectious waste streams. Patients must travel multiple times in a week to the hospital for hemodialysis treatment and the travel adds to carbon emissions and financial burden.
THE INDIAN REALITY:
Many patients in India present late in advanced stage of kidney disease due to lack of awareness on symptoms of kidney disease coupled with cost of health care. This further makes care more intensive and costly. Some hospitals may face water shortages, power-cuts and have limited waste-management systems. Further, our kidney transplant rates remain low and patients remain on long term dialysis. This forced longevity on dialysis creates a massive carbon footprint. A patient waiting 10 years on dialysis for a kidney will generate 5,000 kg of plastic waste and consume 1.5 million liters of water.
SOLUTIONS:
India must expand kidney care access while making hospitals climate-conscious. Doctors, administrators, policymakers, and citizens all have roles to play.
THE BIGGEST SOLUTION: PREVENTION
This warrants screening for signs of early kidney disease with simpler and cheaper tests like blood test for creatinine, urine test for protein leak and blood pressure check. In children, growth failure, bony deformities and high blood pressure could be the tell tale signs of underlying kidney disease. It is imperative to create public awareness on climate change, hydration and heat safety. Early detection of diabetes, hypertension and obesity prevention is must.
The local government can incentivize hospitals to set up effluent treatment plants for dialysis units. It can create a water credit system where hospitals that use reclaimed water for campus greening receive a tax rebate on their municipal water tax. Other measures could be : set up recycling centers for noninfectious clean medical plastics in the hospitals; provide a subsidy for installing solar panels on the rooftops of hospitals to power dialysis and ICU units. It should be mandatory to protect the green cover of the city, provide cleaner air and safer water.
By transitioning a patient from dialysis to transplant, we can stop production of dialysis specific waste like dialyzers, blood lines, saline bags. We can eliminate the high electricity demand required to run the dialysis machines and water treatment plant.
A stable transplant patient may need fewer clinic visits drastically cutting the carbon footprint of transport. Promoting cadaveric organ donation is a quest for sustainability. Every donor who provides two kidneys can potentially save two lives and decommission 2 dialysis slots. It is the need of the hour that all ICU units should try to report potential brain-dead donors to a central registry and promote cadaveric organ donation.
If the planet’s health fails, kidney health will suffer. Sustainable kidney care is the need of the hour.
