146 new cases were recorded in 2015

Health: The drastic increase in chronic kidney disease (CKD) cases in the country is fast emerging as a major burden on the health ministry’s coffer.

Last year, the ministry spent about Nu 20.70 million (M) for 23 successful kidney transplants conducted in India. Similarly in 2013, 17 patients had successful kidney transplants for which the ministry spent about Nu 15.30M. In 2014, 16 patients underwent kidney transplant.

Officials from the referral section at the Thimphu national referral hospital said the figures don’t include expenditure on unsuccessful transplants or on patients who were sent for reviews to India.

Records indicate a steady increase in people suffering from CKD over the years. Dialysis units of Thimphu, Gelephu and Mongar hospitals recorded 146 new cases last year from 119 the previous year. So far this year, the three hospitals recorded 40 new cases, which translate to about 15 cases in less than three months.

From eight cases in 1998, today there are about 149 patients on dialysis at the three hospitals.

Health officials said that a majority of the referrals to India comprises kidney failure transplant. When a patient find a donor, the government funds the transplant and they are referred to Christian Medical College in Vellore and hospitals in Kolkata, India. If not they are put on dialysis until a donor is confirmed.

Health ministry’s chief of healthcare and diagnostic division, Tandin Dorji said when a person is diagnosed with CKD, also known as end stage renal failure disease, the only option left is either transplant or dialysis.

“Both are extremely expensive,” he said.  “Even after kidney transplants, patients have to be on immune-suppressant drugs that are provided for free throughout their lives.”

The best option for the ministry, he said was prevention through reduction of Non-Communicable Diseases (NCD) programmes. Diabetes and hypertension are the two main causes behind the disease although there are also other causes.

The ministry has programmes targeting reduction in NCDs like diabetes and hypertension.

Bhutan Kidney Foundation’s executive director Tashi Namgay said the trend was such that many children are now being diagnosed with CKD. “The emerging cases in children is a concern,” he said.

Although the foundation encourages patients to have donors within the family, Tashi Namgay said most do not seem to understand which is why the patients have to be put on dialysis.

“The hospital guest house in Thimphu cannot handle more patients now with a majority of them being kidney patients. Until they find donors, patients have to be on dialysis for years and stay at the guest house,” he said.

Just before the academic session began this year, Thinley Namgay’s 15-year-old daughter suffered from swelling and loss of appetite. His daughter was admitted briefly in Tsimalakha hospital after which the girl was referred to Thimphu where she was diagnosed with CKD.

She is currently on dialysis as the family is yet to decide who among the members would donate their kidney.

Urologist Dr Lotay Tshering said without a proper study to substantiate, it is early to conclude that the disease was affecting the children more. Dr Lotay Tshering linked CKD to diabetes and hypertension and said it was also infection related. “Infection of the urine or kidneys resulting to stone formation or vice versa,” he said. “One of the main causes of urine infection is not drinking enough water.”

Dr Lotay Tshering also emphasized the need to prevent diabetes, hypertension and infections to control kidney diseases. “Bhutanese drink less water. This leads to dehydration which is why Bhutanese suffer from kidney-related diseases,” he said.

Records with Thimphu referral hospital show that diabetic cases increased to 9,976 in 2014 from 2,541 in 2008, while hypertension increased to 34,941 cases in 2014 from 20,347 in 2008.

Kinga Dema