SRINAGAR: A parliamentary committee has recommended mandatory kidney function tests every six months for everyone aged 20 years and above, besides annual screening of people at high risk of chronic kidney disease (CKD).
The recommendations are part of a proposed shift in India’s approach to kidney disease from treatment of advanced kidney failure to prevention, early detection and slowing the progression of CKD.
The Parliamentary Standing Committee on Health and Family Welfare has suggested that biannual kidney function tests be provided free 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).
The committee, headed by Rajya Sabha member Ram Gopal Yadav, made the recommendations in its 177th report titled “Prevalence of Chronic Kidney Disease in India – Prevention, Diagnosis, Treatment and Management”. The report contains 66 recommendations and was presented in the Rajya Sabha and laid on the table of the Lok Sabha on August 7.
The panel said CKD screening currently remains largely dependent on people visiting Ayushman Arogya Mandirs and other health facilities, resulting in gaps in periodic screening, particularly among high-risk groups.
It recommended institutionalising annual CKD screening for high-risk individuals and mandatory biannual kidney function testing for all people aged 20 years and above.
For those at higher risk, screening should include estimated glomerular filtration rate (eGFR) and urine albumin or protein testing, followed by appropriate referral and follow-up, it said.
Diabetes and hypertension were identified as the principal risk factors, while the panel also recommended periodic screening for people above 60 years, those with a family history of kidney disease, obesity or tobacco use, and individuals with a history of acute kidney injury, recurrent urinary tract infections, kidney stones or prolonged use of potentially nephrotoxic medicines such as non-steroidal anti-inflammatory drugs.
The committee also called for targeted screening of agricultural and occupational populations in areas affected by chronic kidney disease of unknown etiology (CKDu), particularly parts of Andhra Pradesh, Odisha and Karnataka. Heat stress, repeated dehydration and exposure to agrochemicals may contribute to kidney damage in such populations, it noted.
Citing a pooled CKD prevalence of about 13.24 per cent in India, the panel said the disease frequently remains without symptoms in its early stages. As a result, many patients are diagnosed only after substantial and sometimes irreversible loss of kidney function.
It recommended a national CKD screening protocol under the NP-NCD, with standardised screening and referral procedures for high-risk people across primary healthcare facilities, including Ayushman Arogya Mandirs.
In another key recommendation, the committee said every serum creatinine test conducted at public or private laboratories should automatically generate an eGFR report, preferably using the CKD-EPI equation, without requiring a separate test or additional payment.
The panel said serum creatinine alone was not sufficient for early detection because its levels can remain within the normal range despite a significant decline in kidney function. Urine albumin assessment should also be included in kidney-function evaluation for high-risk individuals, it said.
The committee stressed the need to strengthen prevention and awareness at the primary healthcare level, including lifestyle counselling, identification of risk factors and early detection of CKD.
It said India could not continue to depend largely on dialysis and kidney transplantation to address a growing CKD burden and called for greater emphasis on preventing disease and delaying the need for kidney replacement therapy.
According to the report, nearly 2.2 lakh new patients with end-stage kidney disease are added every year, creating demand for around 3.4 crore additional dialysis sessions annually.
The panel noted that annual haemodialysis sessions under the Pradhan Mantri National Dialysis Programme had increased from about 25 lakh to 70 lakh over five years. It recommended expanding the use of peritoneal dialysis, particularly for patients in rural and remote areas.
It also recommended extending post-transplant coverage under Ayushman Bharat PM-JAY from the current 15 days to one year. The extended coverage should include follow-up consultations, essential investigations, immunosuppressive medicines and treatment of transplant-related complications during the first year, it said.
The committee further proposed an integrated digital CKD framework under the Ayushman Bharat Digital Mission, with electronic referral systems, longitudinal patient records and monitoring of high-risk individuals. These systems should be linked to a proposed National CKD Registry.
It also recommended strengthening nephrology services at district hospitals, improving referral mechanisms for specialist care and establishing a separate national programme for paediatric kidney care.
The recommendations aim to establish systematic kidney screening and early intervention while reducing the number of patients progressing to advanced kidney failure and the country’s future dependence on dialysis and transplantation.
