Patient Population Suitable for Renal Transplant Among the Diagnosed End
Stage Renal Disease in A Tertiary Referral Center in South India
Background: An estimated 229 per million population ,are afflicted with end stage renal disease in our country. Chronic kidney disease
poses a health threat and financial burden on patients from developing country like ours, where 70 % of the population are from rural
areas which make them economically vulnerable group. The number of these patients who opt for renal transplant as an option to renal
replacement therapy is uncommon by virtue of this very fact.
Methods: A Study in tertiary care government hospital in South India .Our hospital has an outpatient department of 35,616 patients
annually. The inpatient statistics are 2564 .Our hospital is the only one of its kind in the country. It is also a tertiary care where renal
transplants are done as a renal replacement therapy. The aim is to study the incidence of chronic kidney disease, and the number of them
who have opted for renal transplant as a renal replacement therapy from among the patients who are undergoing dialysis at our institution
for end stage renal disease..
Results: On an average the total number of cases of CKD 1254 cases per year which includes both dialysis and non dialysis patients.
Out of which 426 are cases of end stage renal disease on dialysis. The later patients are then systematically screened for economics of
transplant with aid from the government of Karnataka and compliance quotient. In the end the total percentage of patients from the group
of end stage renal disease undergoing transplant is about 7 %.
Conclusion: The incidence of chronic kidney disease is ever growing however the number of patients who opt for renal transplant
is a small number especially in developing countries like ours. The constraints are many beginning with economics the dynamics of
transplant and patient compatibility amongst others to name a few.
Chronic kidney disease. End stage renal disease. Renal transplant. Renal replacement therapy
India is a vast country with a great urban and rural divide , the
Rural to Urban distribution is 68.84% & 31.16% respectively 3
The annual incidence of end stage kidney disease (ESRD) has
doubled over the past decade to reach about 135 per million in
Europe and a similar rate is seen in USA. It is expected to continue
to rise at an annual rate of around 5–8%.,in absence any renal
registry in India the annual incidence is estimated to be 34–240
per million population, with less than 10% ever get access to renal
replacement therapy like dialysis and transplantation, while less
than 3% continue the therapy life long,3. 25 patients per million
per year undergo renal transplant.1,2
The major barrier to transplantation is money and availability of
live related donor. This discrepancy widens between the rural and
urban population who are in need of renal transplant.
There is limited data on the incidence of chronic kidney disease in
our country also the number who opt for transplantation and finally
get transplanted are even lesser.
Keeping this into account this a study on the incidence of CKD in
tertiary care hospital in south India the proportion of them who opt
for renal transplant.
Materials and Methods
This is a prospective study on nephrology patients in our
nephrology services department with end stage renal disease and
The Aim of the study was to study the incidence of chronic kidney
disease, the number who are in the End Stage Renal disease(ESRD),
among them number who opt for renal transplant as a therapeutic
modality. Subjects with newly diagnosed with CKD were recruited
in the study period from Jan 2015 to December 2015.
diagnosis was based on clinical evaluation, imaging studies
including ultrasound, and estimated glomerular filtration rate
(GFR) calculated using the abbreviated Modification of Diet in
Renal Disease (MDRD) equation .The subset of them who were
diagnosed to have ESRD were evaluated and also who opted for
transplant were studied .
The prospective recipients and their prospective donors were
interviewed separately. The medical and non medical factors that
patient or the donor had were also analyzed.
Out of 1054 patient s of CKDin the study year , 603(57.21%) of
them had ESRD.
Out of these,180 (29.85%) opted for renal tansplant .Males represented
420(69.65%) of the 603 patients with ESRD
THE most common cause of ESRD in the institute was glomerular
265 (43.94%) followed by diabetic nephropathy 175(29.01%) ,interstial
(135(22.38%)and hypertension 28(4.64%). Renal biopsy
established diagnosis in about 243(40.29%) of the cases
Of the 113 (18.1%) who choose conservative therapy poor finances
influenced the decision in 110(97.34%) of them.
Among the 310 (49.75%) patients who chose long term dialysis
as RRT. Here 290(93.5%) of the 310 patients were fit to be a renal
transplant recipient, and finances influenced the decision ..
A trend toward older patients choosing maintenance dialysis as a
modality of RRT and younger people choosing renal transplantation
but it was not statistically significant.
Of the 180 patients with CKD stage 5,who chose renal transplant
as their modality of treatment , 70 (38.8.%) came for recipient
evaluation rest chose to get registered for deceased donor transplantation.,
among the 110 who chose deceased Donor transplant,
54 chose deceased donor in in view of non availability of ,living
donors ,the most cause was ABO incompatibility ,followed by
Motivated, younger patients ,who had government approved
schemes for transplant opted for transplant.
Among the donors ,mother were most common (45(64.28%) followed
by spousal (all wifes) ,the father and brother.
Among them 40(57.14%) were finally evaluated.
Chronic kidney disease has become an important health burden to
the Indian population.
Early detection of renal disease ,prevention and life style
modification, prolong life in these patients., There is ever
widening gap between the number of people waiting for renal transplantation and those who are transplanted . Patient’s choice
of the modality of RRT, in our country, is largely dependent on the
means of financial support for transplantation followed by donor
The males constituted 69.65% of the total population. This was
similar to the 69.6% as per the Indian CKD registry.4],It is likely
that the incidence of the disease per se is more in males .However,
socio economic factors may play a role in their presentation.
In a study form south India the prevalence among men was 60-
70 %5. In A French urban area study, the male: female ratio was
2:1 after the age of 20 years onward6. The proportion of male
patients among each the three sub groups of ESRD were higher as
compared to their female counterparts.
Poor Indians spent 40% of their income on health care while the
rich spent about 2.4%.7 Studies have shown that medical expenses
were one of the main factors pushing people into poverty. Hence
it is not surprising that a large proportion of patients chose
conservative treatment. In our study population
The number of patients who chose conservative treatment, dialytic
treatment, and renal transplant were18.73%, 51.4%, and 33.1%,
respectively, as against the Indian CKD registry data of 75.1%,
22.5%, and2.5%, respectively4Most of the patients who started
dialysis had to continue further hemo dialysis at centre of their
own choice, its quite possible that many wouldn’t have continued
HD due to financial reasons.
Of the 31.7% of the patients who had chosen renal transplant as
their modality of treatment, 22.2% of the initial CKD 5 population
was left with us for further evaluation for living donation , a large
percentage(61.11%) of chose deceased donor transplant as a
Patients choosing renal transplantation as a modality can be high ,
due to our center been a referral hospital caters to the whole state
of Karnataka and a significant number of patients are referred only
for renal transplantation. So our findings are not representative of
the general Population.
Females were the donors for 85.71% of the recipients.
A study from south , India, had reported that two thirds of their
donor population were females and this had only marginally
changed over the last 10 years8 .
The donors volunteered themselves for transplant evaluation in
28% of cases and in the rest, it was requested by the recipient or
suggested by the recipient’s physician.
Among the patients who were finally evaluated only 40 (57.14%)
under went evaluation ,factors responsible were dead of recipient
s ,death of donor ,non wailing donors after initial evaluation, lost
to follow, change of centre .
Renal transplantation is still at a nascent stage in a country like
Counseling regarding donation the apprehensions about
complications of the renal transplant surgery among the donors to
be allayed both for individual donors and the general public and
financial aid may help in improving the donation rates.
- Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey
RM. Prevalence of chronic renal failure inadults in Delhi, India.
Nephrol Dial Transplant. 2005;20:1638–42.
- Modi GK, Jha V. The incidence of endstage renal disease in
India: a populationbased study. Kidney Int. 2006;70:2131–3.
- 3 year cumulative annual report, CKD registry of India. Indian
Society of Nephrology Online Resources.Available from: http://
www.ckdri.org [last cited on 2009 Jul 10] .
- Mani MK. Prevention of chronic renal failure at the community
level. Kidney Int Suppl. 2003;83:S86–9.
- Jungers P, Chauveau P, DescampsLatscha B, Labrunie M, Giraud
E, Man NK, et al. Age and gender related incidence of chronic
renal failure in a French urban area: a prospective epidemiologic
study. Nephrol Dial Transplant. 1996;11:1542–.
- Varatharajan D, Thankappan R, Jayapalan S. Assessing the
performance of primary health centres under decentralized
government in Kerala, India. Health Policy Plan.