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Kidney Disease Management in Gujarat: A Comprehensive Status Report
Corresponding author: Abhijit M. Konnur, Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. E-mail: abhikonnur@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Konnur AM, Banerjee S. Kidney Disease Management in Gujarat: A Comprehensive Status Report. Indian J Nephrol. doi: 10.25259/IJN_229_2025
Abstract
Gujarat has 4.99% of India’s population. The evolution of kidney care began in the 1970s, with the introduction of peritoneal dialysis in 1973 at Civil Hospital, Ahmedabad and the first nephrology services starting in 1978-79. Institutions like Muljibhai Patel Urological Hospital (MPUH) and Institute of Kidney Diseases and Research Center (IKDRC) have been pivotal in the growth, with the first cadaveric transplant being recorded in 1981. Gujarat faces a high prevalence of diabetes, hypertension, and CKD. Around 10,000–13,000 patients are currently on dialysis, and 896 kidney transplants were conducted in 2022. Nephrology services are mainly urban, with 115 nephrologists (13 government, 102 private). Trust-based affordable centers help bridge access gaps. Dialysis is offered at 272 government and 300 private centers, primarily located in cities such as Ahmedabad, Rajkot, Surat, Vadodara, and Valsad. The Gujarat Dialysis Program, run by IKDRC-ITS, uses telemedicine to support patients in remote areas. As of October 2024, only 60–70 patients are getting peritoneal dialysis. Gujarat has 28 kidney transplant centers and is a national leader in deceased donor and paired kidney exchange transplants. There are 105 non-transplant organ retrieval centers. MPUH is a center of excellence in interventional nephrology. For training, Gujarat offers three DM seats (IKDRC) and 11 DNB seats across four major centers. Overall, Gujarat’s kidney care journey showcases notable progress and infrastructure growth.
Keywords
Chronic kidney disease
Gujarat
Hemodialysis
Kidney transplant
Peritoneal dialysis
Introduction
Gujarat, located on India’s west coast, has a population of ∼60 million, with the urban population comprising 42.6%. Ahmedabad is the most populated district (7.2 million), followed by Surat (6.07 million). State-of-the-art nephrology centers of national repute (both private and public sectors) were established quite early. These hospitals still command trust due to quality and affordability.
History
Peritoneal dialysis (PD) was initiated in 1973 at the Civil Hospital, Ahmedabad (CHA), affiliated with the BJ Medical College. The first nephrology unit in Gujarat was established at CHA under the guidance of Drs. DD Patel, NK Bodiwala, and Pravina Shah, around 1978-79. A hemodialysis (HD) program was started in 1978, with the acquisition of three Kiil dialyzers. The first dedicated OPD services were initiated by Dr. HL Trivedi in 1979-80 at CHA. Dr. LJ Shah established dialysis services in the VS Medical College, Ahmedabad. The Muljibhai Patel Urological Hospital (MPUH), Nadiad, was also established in 1978 and was the first dedicated not-for-profit academic medical center for Nephrology-Urology in the private sector. The Institute of Kidney Diseases and Research Centre (IKDRC) or the “Kidney Hospital” was established in 1981. A full-fledged transplant program was soon established in MPUH and IKDRC.
Epidemiology of kidney diseases in Gujarat
Gujarat has a high prevalence of diabetes, pre-diabetes, hypertension, obesity, and dyslipidemia.1 The exact prevalence of CKD is not known. A hospital-based screening study estimated a 20% CKD prevalence, with 8% with eGFR <60 mL/min/1.72m2.2 The prevalence may be higher than the national average. The prevalence of renal stone disease and subsequent CKD, esp. in tribal and Kutch regions, is higher. Currently, there are around 10,000-13,000 patients on dialysis in Gujarat. About 896 kidney transplants were done in 2022 (NOTTO Data).
Conservative care, AKI management, and non-dialysis CKD care
Nephrology services are mostly urban-centric, but visiting nephrologists are usually accessible at sub-divisional levels. Early-stage CKD is underdiagnosed, and late referrals are common. Currently, there are 115 nephrologists, with the majority working in the private sector (approximately 102). Bridging trust-run centers provide high-quality, affordable care.
The Chief Minister Services of Experts at Treatment Unit (CM-SETU)3 is a novel public-private initiative for engaging part-time specialists in government hospitals. Thus, nephrologists are now available in various public hospitals, up to Community Health Centre (CHC) levels. Access to specialist care has been simplified, leading to improved outcomes. This enables protocol-based management of AKI in remote centers. Surat witnesses Leptospira epidemics; other tropical AKIs remain common. Conservative care, including renal function assessment, treatment of inflammatory and infectious renal diseases, neoplastic diseases, and palliative and supportive care for ESKD patients, is available across the state.
Dialysis services
HD is the default choice for renal replacement therapy, primarily due to easy availability, acceptance, nephrologist preference, government support, and lack of clinical coordinators for PD. HD is available at 272 governments and 300 private centers, covered mainly by the Prime Minister National Dialysis Program (PM-NDP) or Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Other patients have private insurance or are self-funded. Most centers are located in urban areas [Table 1].4,5 Only 60-70 patients were on PD as of October 2024 [Box 1]. The recent increase has been due to a policy change in PM-NDP favoring PD reimbursement.
| Number of nephrologists | 115 |
| Number of transplant centers | 28 |
| Number and range of nephrology training programs | |
| DM Nephrology | 1 |
| DM Pediatric nephrology | 1 |
| DNB Nephrology | 5 |
| Number of nephrology trainees (total and passing out annually) | |
| DM Nephrology | 3 |
| DM Pediatric nephrology | 3 |
| DNB Nephrology | 11 |
| Number of centers with intervention nephrology facilities | 20 |
| Number of patients on dialysis (In center HD, home HD, PD) | |
| HD | 13,000 |
| CAPD | 55 |
| APD | 10 |
| Number of transplanted patients (total and annual) | 2023: 818 |
| Living donor | 564 |
| Deceased donor | 254 |
| Current practice of HD and PD (frequency, adequacy) | Mostly HD |
| Vascular access (patients getting dialysis through fistula/AVF) | >70% |
| Any kidney disease registry (CKD/Dialysis/Transplant) and the nature of data collected |
Indian CKD Registry initiated by MPUH4 SNSMDS incident HD study and registry by MPUH5 |
| Research scenario |
Multiple research projects and drug trials run by centers Renal angioplasty research in Wet Lab @ MPUH ICMR funded research on CKDu and Thrombotic microangiopathy at MPUH |
DM: Doctorate in medicine, DNB: Diploma of national board, HD: Hemodialysis, CAPD: Continuous ambulatory peritoneal dialysis, APD: Automated peritoneal dialysis, PD: Peritoneal dialysis, AVF: Arteriovenous fistula, MPUH : Muljibhai patel urological hospital, SNSMDS: Shri Narayandasji Santram Maharaj, Improving Dialysis Outcomes Study, ICMR: Indian council of medical research
The Gujarat dialysis program
The Gujarat dialysis program (GDP), a free dialysis program under PMNDP, was possible due to the efforts of IKDRC-ITS (supported by the state) to extend quality dialysis across the state. With a mission to provide dialysis within 30-50 km of each patient, centers in PHC, CHC, medical colleges, etc., were established rapidly (272 centers, the highest in India). Technicians from the local community are trained at IKDRC-ITS. All units and patients are remotely monitored from IKDRC-ITS’s telemedicine center. During the COVID-19 pandemic, Mobile Dialysis Units were a unique initiative by IKDRC-ITS, providing dialysis services at non-renal and smaller COVID-centers in and around Ahmedabad. Unlike most states, dialysis services were unaffected by the pandemic, as they were amalgamated under a single management.
Kidney transplantation
The first renal transplant was done on 17th September 1979 at IKDRC-ITS, Ahmedabad, and 6th April 1980 at the Muljibhai Patel Urological Hospital (MPUH) in Nadiad. MPUH became the first center offering regular transplant services. Currently, there are 28 kidney transplant centers, IKDRC being the only government sector. In 2022, 617 living donor kidney transplants were performed, 37% (229) of which took place at IKDRC-ITS, one of the most prolific transplant centers in India. MPUH is the largest private-sector transplant center, with 3,185 (predominantly living donor) transplants between 1990 and 2020, with 90.6%, 82%, 1- and 5-year graft survival, respectively. Twelve centers offer multi-organ transplant facilities. Kidney transplant is covered under AB-PMJAY in IKDRC and some medical college hospitals. Other patients are covered under private or group insurance or pay out-of-pocket. IKDRC-ITS also operates a highly subsidized pharmacy, which includes immunosuppressants.
Innovations in kidney transplantation
Gujarat has been a leader in transplant innovations. The tissue typing lab at IKDRC-ITS was established in collaboration with Prof. Paul Terasaki, enabling the routine use of state-of-the-art technologies. Dr. H.L Trivedi, the founder-director of IKDRC-ITS research, was involved in transplant tolerance induction using stem-cell protocols in the 2000s aimed at minimizing the dose and duration of immunosuppressives.6,7 This strategy has fallen out of fashion since his demise.
Paired kidney exchange (PKE) using innovative strategies like non-simultaneous and non-anonymous exchange was pioneered by Prof. Vivek Kute at IKDRC-ITS and reported excellent outcomes.8-10 The kidney transplant surgical team at IKDRC-ITS, under the leadership of Prof. Pranjal Modi, also led the widespread use and acceptance of retroperitoneoscopic donor nephrectomy.11
Deceased donor kidney transplant
Gujarat has consistently been among the top five states in deceased donor kidney transplant (DDKT). IKDRC-ITS has formed the SOTTO since 2019. The state has about 116 registered retrieval centers. SOTTO has ensured uniform organ allocation to all transplanting centers. Organ allocation is done by an elaborate point system, with a (donor) HLA-based allocation using virtual cross-matching. An 8-year follow-up data (N=943) reported 70% patient survival and 84% death-censored graft survival.12 Organ wastage is practically zero, owing to IKDRC-ITS being a government-based transplant center, and overhead charges are manageable.
Intervention nephrology
Interventions are integral to the current nephrology curriculum. MPUH has been a pioneer center and is currently a center of excellence for interventional nephrology services and training. While guided biopsies and tunneled catheterization are routine procedures, interventional nephrologists currently provide renal (or allograft) angiographies, angioembolization, and vascular access rescue therapies. Minimally invasive techniques reduce patient discomfort and improve overall outcomes. Similar facilities are available in IKDRC and other cities.
Diagnostics, essential treatment, and other services
All regions within the state have access to advanced imaging and pathology services related to nephrology. Pediatric nephrology services are available in IKDRC (with the first public-sector DM program) and BT Savani Hospital, Rajkot, apart from other private providers. A large government-funded genetic screening project for CKDu is also ongoing at MPUH.
Treatment funding scenarios, eligibility, and out-of-pocket expenditure
Poor patients benefit from government schemes, including AB-PMJAY, BPL and SC/ST scheme, and the School-Health Program. These are supplemented by several by philanthropic organizations. Patients from outside Gujarat may need to finance their own care if they are ineligible for welfare health schemes.
In conclusion, the evolution of kidney care services in Gujarat reflects a commendable journey. While success is evident, addressing challenges requires a concerted effort involving healthcare providers, policymakers, and the community. By continuing to invest in infrastructure, promoting awareness, and implementing targeted policies, Gujarat can further strengthen its kidney care services and improve the overall health outcomes.
Conflicts of interest
There are no conflicts of interest.
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