…researchers call for aggressive advocacy and awareness programmes

Lhakpa Quendren

Hypertension has emerged as the primary cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among the majority of middle-aged individuals in the country, as indicated by a recent study conducted by Minjur Dorji and the team from the National Referral Hospital (JDWNRH).

In their retrospective descriptive study titled “Aetiology of End-Stage Renal Disease,” carried out at JDWNRH between 2019 and 2020, hypertension stood out as the leading non-communicable disease contributing to ESRD.

The study, encompassing 202 patients aged between 15 and 85 years (107 females and 95 males), aimed to uncover the root causes of ESRD in the nation.

The study unveiled that hypertension accounted for 20.8 percent of ESRD cases, followed by chronic glomerulonephritis at 12.9 percent and diabetes mellitus at 8.9 percent. Lesser common causes included herbal nephropathy, heredofamilial factors, and obstructive nephropathy.

However, the study did not delve into the mechanisms of herbal treatment causing ESRD, posing a challenge in categorising it as a definitive cause.

Remarkably, causes for 50 percent of the patients remained unexplained, as treating physicians did not specify them.

The study identified a minority of ESRD patients in the younger age group, urging further investigation into these unexplained aetiologies.

The majority of patients (68.8 percent) fell within the middle age group of 24 to 60 years, with the high prevalence attributed to the natural deterioration of overall renal function with advancing age. Females constituted 53 percent of ESRD patients, indicating a potentially higher risk for females compared to males.

International studies linking wealth growth to lifestyle-related diseases such as obesity, diabetes, and hypertension underscored the risk factors for CKD and ESRD. This impact is particularly pronounced in resource-poor developing countries, including Bhutan, where a noticeable increase in ESRD patients has become a matter of serious concern.

The authors emphasised that the repercussions of ESRD extend beyond the physical progression of the disease, affecting patients’ mental well-being, social dynamics, and imposing financial burdens.

The government, in turn, grapples with accelerated depletion of financial resources, human assets, and essential services.

In response to this health crisis, the authors issued a call for urgent measures to control and prevent hypertension through heightened awareness and proactive management. They highlighted a lack of comprehensive and accurate information hindering the implementation of effective policies and interventions.

The authors recommended an aggressive advocacy and awareness program for lifestyle-related diseases, coupled with personal-level prevention and timely treatment of hypertension. They stressed the importance of preventing the toll of the disease on individuals collectively.

The study also identified a deficiency in baseline information on demographics and causes of CKD and ESRD, crucial for developing key strategies such as prevention, early diagnosis, and timely treatment.

The findings are anticipated to guide policymakers and planners in shaping relevant policies, strategies, and program realignment to alleviate the strain on dialysis services, mitigate economic impacts, and ease financial burdens on the government and society.

However, recognising the limitations of the study, which focused solely on the national referral hospital, the authors advocated for a well-planned, prospective, and multi-center study covering the entire country’s population to generate accurate and comprehensive scientific data.

This, they argued, is essential in addressing the rising burden of CKD/ESRD and mitigating its adverse consequences on the quality of life, morbidity, mortality, and socio-economic aspects for patients, their families, and society at large.