Summary

The Kidney Help Trust (KHT) was founded by Dr. M.K. Mani, Chief Nephrologist of the Apollo Hospital, Chennai, who believes that prevention needs to play a greater role in reducing the incidence of catastrophic health spending that is often associated with the treatment of chronic diseases.

Program goals

The goal of the Trust is to dramatically reduced the incidence of renal diseases in 26 villages near Chennai where KHT operates. The Trust has developed a cost-effective protocol for the early detection and prevention of kidney failure. Taking into account the fact that diabetes and hypertension are contributors to kidney disease, preventing and controlling these conditions can help protect against an individual against kidney damage.

Key program components

KHT's service delivery model is based on the fact that renal disease is undetectable at an early stage by looking at the candidates head or heart, but is through urine and blood samples. Thus, KHT developed methodologies to test the sugar and protein content of urine samples.

KHT workers (usually girls from the area trained in basic healthcare) ask each villager a simple set of questions related to sugar intake and blood pressure, and collect a urine sample to be examined at the site. Blood pressure is recorded for all individuals over the age of five.

Patients who test positive by answering any of the questions in the affirmative, who have a high blood pressure - over 140/90, or who have sugar or protein in the urine, are examined by a doctor of the Trust. The initial patient testing is done free of charge by Apollo Hospitals. Diabetes is treated with glibenclamide and metformin, and hypertension with reserpine, hydralazine and hydrochlorothiazide - all low-cost, yet efficient drugs.

Monitoring of blood pressure is done at weekly intervals by the health workers, and diabetes is monitored with the glycated haemoglobin carried out every three months. Doses of medicine are adjusted to achieve good control. The Trust had been running the programme since 1997 and covers a population of 23,000, treating diseases such as diabetes and hypertension with the cheapest available drugs.

An initial evaluation of KHT's approach to early detection of renal diseases has shown that only 8/1000 villagers in the communities where the Trust operates were found to have a glomerular filtration rate (GFR) of below 80 ml/minute, indicating the necessity for treatment. When KHT conducted a study of the population of adjacent villages not covered by the programme, 33/1000 villages were found to have renal diseases.