New Delhi, Aug 11: A parliamentary committee has recommended mandatory kidney function tests every six months for everyone aged 20 years and above, along with annual screening of all high-risk individuals, as part of a policy shift from treating advanced kidney failure to preventing and slowing disease progression.
The Parliamentary Standing Committee on Health and Family Welfare has recommended that the biannual kidney function test (KFT) be provided free of cost to people below the poverty line and at a nominal cost to those above the poverty line under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD).
For high-risk individuals, the screening should include assessment of kidney function using estimated glomerular filtration rate (eGFR) and urine albumin/protein testing, along with appropriate referral and follow-up, the panel said.
In its 177th report on “Prevalence of Chronic Kidney Disease in India – Prevention, Diagnosis, Treatment and Management”, the committee headed by Rajya Sabha member Ram Gopal Yadav made 66 recommendations covering prevention, early detection, diagnosis, treatment and management of chronic kidney disease (CKD).
The report was presented in Rajya Sabha and laid on the table of Lok Sabha on August 7.
The committee said the existing approach to CKD screening was largely opportunistic and depended on individuals visiting Ayushman Arogya Mandirs and other health facilities, which did not ensure periodic screening of all high-risk people.
“The committee, therefore, recommends that the ministry institutionalise regular annual CKD screening of all high-risk individuals and mandatory biannual kidney function test (KFT) of all persons aged 20 years and above, free of cost for persons Below Poverty Line (BPL) and on nominal cost for Above Poverty Line (APL) persons under the NP-NCD to enable early diagnosis and delay disease progression,” the report said.
The panel said the principal high-risk groups requiring periodic screening included people with diabetes and hypertension, which together account for the majority of CKD cases in the country.
Other priority groups include adults above 60 years, people with a family history of kidney disease, obesity or tobacco use, and those with a history of acute kidney injury, recurrent urinary tract infections, recurrent kidney stones or prolonged exposure to nephrotoxic medicines, including non-steroidal anti-inflammatory drugs (NSAIDs).
It also called for targeted screening of agricultural and occupational populations in regions affected by chronic kidney disease of unknown etiology (CKDu), particularly parts of Andhra Pradesh, Odisha and Karnataka, where heat stress, recurrent dehydration and agrochemical exposure may contribute to kidney damage.
The committee cited a pooled CKD prevalence of about 13.24 per cent in India and noted that the disease often remains asymptomatic during its early stages, resulting in diagnosis only after significant and sometimes irreversible loss of kidney function.
It recommended a national CKD screening protocol under the NP-NCD, with mandatory standardised screening pathways for high-risk individuals across all primary healthcare facilities, including Ayushman Arogya Mandirs.
A key recommendation is that every serum creatinine test conducted in public and private diagnostic laboratories should automatically include an eGFR report, preferably calculated using the CKD-EPI equation, without a separate test request or additional cost to the patient.
“Serum creatinine alone was inadequate for early detection, as levels can remain within the normal range despite significant loss of kidney function. It has therefore recommended that public and private laboratories automatically calculate eGFR, preferably using the CKD-EPI equation, whenever serum creatinine is tested. Urine albumin assessment should also form part of kidney-function evaluation for high-risk individuals,” it said.
The panel noted that reliance on serum creatinine alone was inadequate for early detection and said automatic eGFR reporting would facilitate timely clinical intervention and referral.
The committee also called for a prevention-first approach under the NP-NCD, with Ayushman Arogya Mandirs playing a greater role in kidney-health awareness, lifestyle modification, risk-factor counselling and early identification of CKD.
It said a country facing a substantial and continuously growing CKD burden could not afford to rely predominantly on dialysis and transplantation.
“There is an urgent need to reorient national priorities towards prevention, early detection and slowing disease progression, so as to reduce the future demand for kidney replacement therapy,” the committee said.
The report noted that nearly 2.2 lakh new patients with end-stage kidney disease are added every year, creating an additional demand of about 3.4 crore dialysis sessions annually.
On dialysis, the panel noted that annual haemodialysis sessions under the Pradhan Mantri National Dialysis Programme have increased from about 25 lakh to 70 lakh over five years, but recommended greater use of peritoneal dialysis, particularly in rural and remote areas.
The committee also recommended extending post-transplant coverage under Ayushman Bharat PM-JAY from the existing 15 days to one year, covering follow-up consultations, essential investigations, immunosuppressive medicines and management of transplant-related complications during the first year.
It further called for an integrated digital framework for CKD under the Ayushman Bharat Digital Mission, including electronic referral pathways, longitudinal patient records and monitoring of high-risk individuals, linked to a proposed National CKD Registry.
The panel also recommended strengthening nephrology services at district hospitals, improving specialist referral mechanisms and establishing a separate national programme for paediatric kidney care.
The recommendations seek to move India’s CKD response towards prevention, systematic screening, early diagnosis and slowing disease progression, while reducing the future dependence on dialysis and kidney transplantation. (PTI)
