Upgrading Nephrology Training Among the Doctors to Combat Chronic Kidney Disease (CKD) Epidemic - Now is the Time to Act

Dear Editor,

Chronic kidney disease (CKD) affects 1 in 10 adults. Kidney disease-related mortality is projected to be the fifth leading cause of death by 2040.¹ Diabetic kidney disease, chronic interstitial nephritis, glomerulonephritis and CKD of unknown etiology (CKDu) are the common causes of CKD India.² The prevalence of diabetes in India, which is the most common cause of end-stage kidney disease (ESKD), has jumped from 77 million in 2019 to 101 million in 2023. This increase in diabetes cases will cause an epidemic of CKD in the near future.

The Ministry of Health and Family Welfare, Government of India, released the Rural Health Statistics for the year 2021-2022 on January 12, 2023 about 31,053 primary health centres (PHC) and 6,064 functional community health centres in the country. Primary care physicians working at rural health sector need to be trained in early identification and treatment of acute CKDs. This can be achieved by linking PHCs to secondary and tertiary care centres to ensure continuous education, knowledge sharing, manpower training, infrastructure development, and referral.

National Medical Council defines 31 competencies in nephrology for the undergraduate course.³ Newer competency like interpretation of kidney health data and dialysis catheter insertion procedure should be included for proper management of kidney diseases at all levels.

We suggest the following specific strategies

1. Incorporation of newer competency in CBME curriculum.

2. Collaboration between hospitals providing nephrology services and community health services.

3. Integrative classes on renal physiology, pathology, general medicine, and community medicine for a holistic approach toward prevention and management of kidney diseases in undergraduate curriculum.

4. Case-based bedside teaching in undergraduates with emphasis on common kidney diseases.

5. Clinical posting in Nephrology department for practical exposure but creating interest in this subject.

6. Regular internal assessment during clinical posting.

7. Exposure to nephrology services in the community health centre during internship.

8. Promoting locally relevant research in the area of kidney health for undergraduates/interns/PG trainees.

9. Nursing and paramedics including students studying public health should be properly oriented towards kidney diseases.

10. Students should be trained to diagnose kidney disease in their own family and relatives.