World Kidney Day was marked Thursday with the theme 'Are Your Kidneys OK? – Detect early, protect kidney health'. This sends the message that kidney disease can be detected before it becomes serious. If not, it can lead to 'kidney failure'.

Studies have shown that one in every 10 people will develop chronic kidney disease. South Asian countries have a higher risk of developing chronic kidney disease due to rising rates of diabetes and high blood pressure. Chronic kidney disease, which is particularly prevalent among the elderly and those with diabetes, is also increasingly affecting low- and middle-income countries.

According to a study report by the World Health Organisation in 2008, more than 90 per cent of patients suffering from kidney failure in developing countries like Nepal died within a few months.

In the past, there was no kidney transplant facility in Nepal, and dialysis services were very limited. Most Nepalis were unable to travel abroad for kidney transplants, and those who underwent dialysis could not afford the monthly expenses of Rs. 40- 50,000. Hence, most of the kidney patients died within a few months.

Towards the end of 2008, kidney transplants started at the Bir Hospital and Tribhuvan University Teaching Hospital, giving hope to kidney patients. The government decided to set up a separate super specialised hospital to treat people with various organ failures, and the Shahid Dharmabhakta National Transplant Centre (SDNTC) was born in 2013. This became the basis for expanding dialysis and kidney transplants across the country.

In the process of expanding dialysis in various parts of the country, the centre established dialysis services in government hospitals in Janakpur in the east and Dhangadhi in the west by providing its own machines and manpower. Thereafter, it helped the government purchase dialysis machines and played an important role in expanding the service by training more than 1,000 nurses, doctors and other technicians necessary. Today, free regular dialysis services have been expanded to more than 100 centres across the country, helping to save the lives of about 8,000 kidney failure.

Serious gender discrimination has, however, been found in organ donation and transplantation. When the author performed the first 99 kidney transplants at the Bir Hospital, 90 percent of the donors were women and 90 percent of the recipients were men. Such a high level of gender disparity is rarely found in other fields. To reduce this, it is necessary to provide financial assistance to male organ donors and conduct various public awareness programmes to ensure that women and men have equal status in society.

Our transplantation regulations provide for giving three times more points to women than men in the allocation of kidneys obtained from brain-dead donors. Recently, there has been some reduction in gender discrimination in organ donation and transplantation. According to the statistics available at the centre, 79 percent of the recipients of kidney transplants are men, while 21 percent are women. Among the kidney donors, 28 percent are men and 72 percent are women. As far as the author knows, nowhere else in the world are women given priority in the distribution of kidneys obtained from brain-dead donors. The SDNTC has been continuously working for such liberal laws and equal rights and benefits in women's health.

A study conducted at our centre reveals an alarming statistic: 28.9 per cent of kidney transplant recipients and 27.4 per cent of patients undergoing hemodialysis are returnee migrant workers from the Gulf countries. This suggests that the working conditions in these countries may be adversely affecting their kidney health. In response to this critical issue, the SDNTC is collaborating with the Ministry of Labour, Employment, and Social Security to implement comprehensive health screening and counseling for workers before they leave Nepal. Furthermore, the centre is planning to establish a helpline to provide migrant workers with access to consultations regarding their kidney health.

In less than 13 years since its establishment, the centre has been performing kidney transplants, with a success rate of 99 per cent. The centre is among the world's largest transplant centres due to the fact that kidney transplant services are free of charge and up to 200 transplants are done annually. The annual demand for kidney transplants is about 3,000, but considering the availability, only 300, including 70 percent (200) from the centre and about 100 from other hospitals, is a very low number. Under the leadership of SDNTC, kidney transplant services are being expanded to all seven provinces of the country. Kidney treatment in Nepal has made a huge leap forward, with 98 percent of those undergoing kidney transplants and 93 percent on dialysis are now surviving at this center.

This National Transplant Centre of the Ministry of Health and Population does not have a building of its own. If suitable land is obtained, the centre can build a 300- 500 bed hospital on its own. Successive governments have repeatedly announced to develop this centre into an Academy of Transplant Science to produce the manpower required to expand the center's services nationwide, but this has not been realized till date.

As we strive to keep our kidneys healthy, here are a few tips: Do regular physical exercise, avoid junk food, control your body weight, do not smoke or drink alcohol, control diabetes and high blood pressure, do not take over-the-counter medicines and antibiotics without consulting a doctor, drink plenty of water, and get your kidneys and other organs checked at least once a year to see if they are healthy.

The author is a kidney and liver transplant specialist