The Anguish of CKD Patients in KP’s Hazara Division

Shazia Mehboob

Islamabad: In Khyber-Pakhtunkhwa, the lack of specialised healthcare facilities are adding to health complications caused by conditions such as hypertension and diabetes. An early diagnosis could help to prevent and control further complications, whilst also saving people their hard-earned income on treatment and transportation.

Lack of affordable specialised healthcare facilities in the districts not only prevents people from getting timely medical advice and treatment, but also adds to the burden of provincial health care, not to mention the damage to the provincial and national economy.

The low-income sectors of population particularly in newly established districts of Kohistan region, Torghar and Battagram, often run the risk of communicable and non-communicable diseases due to lack of awareness, late diagnosis and costly treatment. Lower Kohistan, a district of KP with over 200,000 population, is only one such example of a poor health system.The district has a facility of Type-C hospital but all ten allocated posts of specialised doctors have remained vacant since the hospital’s upgrade in 2016 by the then chief minister, Pervez Khattak, after Kohistan region was assigned the status of three separate districts.

The tertiary healthcare facility should have at least 24 medical officers (MOs), including 10 specialised doctors in different fields, but it is currently operational with only four MOs.

A senior official at the District Health Department on condition of anonymity told The PenPK.com that the district health department has made several efforts to immediately hire qualified staff for the vacant posts but their efforts have not been fruitful.

The government requires the hospital to have at least 10 specialised doctors but this requirement remains unfulfilled. The hospital even lacks basic testing facilities, for example immunology analysers, according to the senior official. The hospital caters to an estimated 1,800 to 2,000 patients per month who visit the hospital from 10 union councils.

Regarding socio-economic conditions, the senior official informed that a large population in the region is living below the poverty line. Many are not able to afford treatment for chronic diseases due to the lack of healthcare facilities here.There are thousands who can’t afford treatment and transport charges to visit Abbottabad or Mansehra. A one-way travel costs Rs5000 to Rs6000 from Kohistan to Abbottabad, and a single trip from Kohistan to Abbottabad can cost Rs30,000 to Rs35,000.

“Those who can afford treatment take their patients to Mansehra or Abbottabad, but those who can’t have to suffer chronic diseases such as kidney-related till death. This is deplorable”, he said.

Ayub Teaching Hospital Assistant Professor of Nephrology Dr Ayesha Aziz stated that a large number of kidney patients who visit the hospital are from Kohistan, Torghar, Battagram, and other surrounding regions.

“Many patients don’t even have fare to travel back home or purchase medicines. Therefore, we have a separate charity section that compensates them,” said Pakistan Kidney Centre Abbottabad Founder Dr Khalilur Rehamn. PKC is a non-profit hospital providing free of cost treatment facilities to the needy kidney patients.

Hypertension is a growing cause of kidney disease in the region, and the lack of healthcare facilities and costly treatment adds to their problems: PKC Dr Khalilur Rehman 

The nephrologists said remote regions have unknowingly hypertension, which leads to Chronic Kidney Disease (CKD) among people. The compromised healthcare system, financial limits and lack of awareness further complicated the situation in the region.

“CKD is a major public health problem with numerous social and economic implications for the general public that can be controlled through comprehensive preventive strategies and lifestyle modifications,” stated Dr Rehman.

Kidney stones are the leading cause of kidney failure in urban areas but hypertension is the leading cause in this region, particularly among the young age group, apprised Dr Ayesha Aziz.

Due to a lack of awareness and missing treatment facilities, thousands in this region live with hypertension and diabetes unknowingly for years, which leads to CKD, informed Dr Ayesha, adding that “early diagnosis can prevent patients from kidney failure”.

“We have conducted hundreds of screening camps in the region,” said Dr Rehman adding that an estimated 60 per cent to 70 per cent of people in the region have lived with hypertension for years but they didn’t even know about it. However, he added, they have some awareness of diabetes and take medicines.

Glomerular disease is a growing health risk for young people living in these districts: Dr Ayesha Aziz

Unlike other regions, young people in northern areas of the country are more affected by kidney disease due to hypertension, she said, adding that “unchecked hypertension for a long period is leading to kidney failure here.”

About women’s health, the lady nephrologist said women are more susceptible to the risk of kidney failure due to reproductive factors, adding that self-medication among people like recurrent use of Dicloran, Ponstan and other medicines are some additional factors leading to the kidney diseases.

Around 400 to 500 patients are being treated in Ayub Teaching Hospital, Abbottabad. The hospital has seven dialysis machines and an estimated 120 patients are being treated in OPD, which is held once in a week.

There are some positive developments as far as specialised healthcare facilities are concerned and one such is the government’s health card scheme. The patients, who were earlier unable to treat patients due to financial reasons, are approaching hospitals for treatment, Dr Ayesha Aziz mentioned.

The teaching hospital didn’t have a specialised facility for kidney patients here, and patients were referred to Peshawar or Islamabad for dialysis. But now the hospital has a dialysis facility but for limited patients, she added. It is to be mentioned here that in private setups, the kidney treatment needs an estimated Rs25,000 to Rs30,000 ; whereas in public setups, the treatment needs Rs6,000 to Rs7000.

There is a need to improve healthcare facilities in public settings to ensure equal access to healthcare for people in the region, Dr Aziz said.

Although the government was allocating posts for nephrologists and doctors are taking interest in specialising in this field, it would also need to improve treatment facilities in order for the reforms to be delivered to the common people, she maintained.

Nephrologist Dr Khalil added that kidney diseases are a growing epidemic not only in Pakistan but all over the world due to their high death rate. There are multiple factors behind its growth. However, in Pakistan, a lack of awareness and a shortage of health facilities for kidney patients have further complicated the situation.

While referring to research studies that have been conducted around the world over, he predicted that by the end of this century, kidney disease would be the leading cause of death in the world, including Pakistan, as well as cancer and other chronic diseases.

It is important to mention here that there is no centralised data mechanism available to get related information on kidney patients in Pakistan and treatment facilities are also not at par with the number of patients.According to high-quality studies, the overall CDK prevalence among Pakistani adults was 12.2 per cent and highest CKD prevalence in Pakistan was reported as 29.9 per cent, and the lowest prevalence was 12.5 per cent.

The study found the highest prevalence of CKD among elderly participants aged more than 50 years (43.6 per cent) and the lowest prevalence among comparatively younger participants aged less than 30 years (10.5 per cent).

In a survey conducted in 2011 in Karachi, as much as 25.3 per cent had some degree of reduced glomerular filtration rate (GFR) with 5 per cent having moderate CKD. The more disturbing was the fact that only 2.3 per cent of individuals were aware of having renal disease, with most people with lower incomes falling into this category.

In this sub-set, 20 per cent had coexisting diabetes, 65 per cent had HTN, and 10 per cent had both conditions. Extrapolation of these findings translates to 12.86 million Pakistanis above 30 years of age having some degree of renal impairment, which is representative of a huge degree burden.

Year	Dialysis	OPD	Surgeries	Total
2015	3046	1042		4088
2016	4601	2901		7965
2017	5827	2376		9375
2018	7808	1880		12661
2019	9189	2478		14215
2020	9436	2524	26	13231
2021	11102	4144	519	18004
2022	16390	5009	1029	27684
Total	67399	22354	1567	91,320

Data Source: Pakistan Kidney Centre, Abbottabad