India’s 177th Parliamentary Report recommends 66 measures to strengthen CKD prevention, early detection, treatment, dialysis and transplantation.
- India had an estimated 138 million adult CKD cases in 2023
- The report recommends 66 measures across the kidney-care continuum
- Prevention and early detection could help delay kidney failure
The 177th Report of the Parliamentary Standing Committee has recommended 66 measures spanning prevention, screening, diagnosis, treatment, dialysis, transplantation, research and long-term care (1✔ ✔Trusted Source
Press Release On The 175th , 176th And 177th Report Of Parliamentary Standing Committee On Health & Family Welfare
).
But the urgency becomes clearer when the recommendations are viewed against the latest Global Burden of Disease 2023 analysis published in The Lancet.
The study estimates that 788 million adults aged 20 years and above were living with CKD globally in 2023, compared with 378 million in 1990. India accounted for an estimated 138 million cases, second only to China’s 152 million. India’s age-standardised CKD prevalence was estimated at 16.0%, compared with 14.2% globally (2✔ ✔Trusted Source
Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023
Go to source)(3✔ ✔Trusted Source
Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023
Most importantly, most people with CKD are in stages 1–3, with a combined global prevalence of 13.9%. This means that the visible population requiring dialysis or transplantation represents only the advanced end of a much larger disease burden.
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The Real Opportunity Is to Prevent Progression
This is where the Parliamentary report could have gone even further.
The Committee rightly calls for prevention, screening and early detection. But India’s response should not become predominantly a programme for identifying CKD and subsequently providing dialysis.
The goal should be to prevent people with early kidney disease from progressing to kidney failure in the first place.
The Lancet analysis identifies high fasting plasma glucose, high BMI and high systolic blood pressure among the leading contributors to CKD-related disease burden (3✔ ✔Trusted Source
Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023
This means that kidney disease prevention must be embedded within India’s existing programmes for:
Kidney health cannot be the responsibility of nephrologists alone.
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Screening: The Ambition Needs an Evidence-Based Framework
The Committee’s recommendation for biannual kidney assessment for everyone aged 20 years and above sends a powerful message about the importance of early detection.
However, this particular recommendation deserves further evaluation before being implemented universally.
The report does not establish why 20 years should be the starting age or why twice-yearly assessment is the appropriate interval for an otherwise healthy, low-risk individual.
A more evidence-based approach would initially prioritise people at substantially increased risk—particularly those with diabetes, hypertension and other recognised CKD risk factors—and determine screening frequency according to risk.
Current KDIGO guidance supports more frequent assessment in people at higher risk, while recommending at least annual assessment of GFR and albuminuria in people who already have CKD (4✔ ✔Trusted Source
Kdigo 2024 Clinical Practice Guideline For The Evaluation And Management Of Chronic Kidney Disease
The question, therefore, is not simply:
That evidence should underpin India’s national screening policy.
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Screening Must Also Mean the Right Tests
A kidney-health strategy should not rely simply on serum creatinine.
Assessment needs to incorporate eGFR and urine albuminuria, because both provide important information about kidney disease and prognosis. KDIGO’s current framework explicitly emphasises assessment of both GFR and albuminuria (4✔ ✔Trusted Source
Kdigo 2024 Clinical Practice Guideline For The Evaluation And Management Of Chronic Kidney Disease
India therefore has an opportunity to develop a simple primary-care Kidney Health Check, particularly for people with diabetes, hypertension and other high-risk conditions.
The National CKD Programme Is the Right Platform—but Prevention Should Be Its Centre
The recommendation for a dedicated National CKD Programme, along with a National CKD Registry, is one of the strongest elements of the report.
The proposed registry should not merely count patients.
It should allow India to answer questions such as:
- How many people have early CKD?
- How many are progressing?
- Which risk factors are driving progression?
- Which States and districts have the greatest burden?
- How many people reach kidney failure each year?
- How many progress to dialysis?
- How many receive transplantation?
- What proportion of patients are detected before advanced disease?
A registry linked to ABDM and PMNDP could make this possible.
Dialysis Is Essential—but It Should Not Become the Measure of Success
India certainly needs more equitable access to dialysis, peritoneal dialysis and transplantation.
But there is a danger in measuring the success of a national kidney programme by the number of dialysis centres created or patients dialysed.
Dialysis treats kidney failure; it does not prevent CKD
With 138 million Indian adults estimated to have CKD, the scale of the problem is far beyond the population currently requiring kidney replacement therapy (3✔ ✔Trusted Source
Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023
).
The more meaningful indicators would be:
How many cases are detected early?
How many progress to advanced CKD?
How many cases of kidney failure are prevented or delayed?
That would shift the emphasis from a renal replacement programme to a kidney-health
CKDu Needs a Parallel Prevention Strategy
The Committee is also right to highlight CKD of unknown etiology, particularly among agricultural and vulnerable populations.
Heat stress, recurrent dehydration, occupational exposures, pesticides and water quality require investigation and intervention.
This is especially relevant as climate-related heat exposure increases. The GBD 2023 analysis also identifies non-optimal temperature among the contributors to CKD burden (3✔ ✔Trusted Source
Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023
Transplantation Must Remain Part of the Continuum
The report’s recommendations on transplantation are important, particularly regarding regional inequities, deceased organ donation and post-transplant care.
The recommendation to extend AB-PMJAY post-transplant coverage from 15 days to one year is particularly significant.
But transplantation should be viewed as one component of the continuum:
Prevention → Early detection → Treatment → Slowing progression → Kidney failure prevention → Dialysis → Transplantation → Lifelong graft care
The ultimate objective should be to reduce the number of people reaching the final stages of that pathway.
India May Be Facing a Silent Kidney Crisis
The word “epidemic” should be used carefully—the Lancet study describes a very large and rising global CKD burden but does not formally classify India’s CKD situation as an epidemic.
Nevertheless, the numbers warrant an epidemic-level public-health response.
India has an estimated 138 million adults living with CKD, an age-standardised prevalence of approximately 16%, and a large proportion of disease remains in the earlier stages.
That is precisely why prevention matters.
If India waits until these patients develop advanced CKD, the country will face an enormous future burden of dialysis, transplantation, cardiovascular disease, disability and healthcare expenditure.
The Next Step: From Kidney Disease Care to Kidney Health
The 177th Report provides an important framework. Its greatest contribution may be that it places CKD firmly on the national health-policy agenda.
But the next stage should be to translate its recommendations into an evidence-based national kidney-health strategy, with measurable targets for prevention and early detection.
India should move from:
That shift—from dialysis-centred care to prevention-centred kidney health—could ultimately have a much greater impact on India’s CKD burden.
This is where the 177th Report, strengthened by the latest Lancet evidence, has the potential to become a turning point in India’s kidney-health policy.
Frequently Asked Questions
Q: How many people in India have CKD?
A: An estimated 138 million adults had CKD in 2023.
Q: What is chronic kidney disease?
A: A long-term condition in which kidney function or structure becomes abnormal.
Q: What are the major risk factors for CKD?
A: Diabetes, high blood pressure, obesity and other metabolic and environmental factors.
Q: Can CKD be prevented?
A: Many cases can be prevented or progression can be slowed by controlling risk factors and detecting disease early.
Q: What tests detect CKD?
A: eGFR and urine albuminuria are key tests for assessing kidney health.
Q: Does everyone need CKD screening?
A: Risk-based screening can help prioritise people most likely to benefit from early detection.
Q: Can CKD lead to kidney failure?
A: Yes. Advanced CKD can progress to kidney failure requiring dialysis or transplantation.
References:
- Press Release On The 175th , 176th And 177th Report Of Parliamentary Standing Committee On Health & Family Welfare – (https://www.pib.gov.in/PressReleasePage.aspx?PRID=2296281®=48&lang=2)
- Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023 – (https://www.sciencedirect.com/science/article/pii/S0140673625018537)
- Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023 – (https://pubmed.ncbi.nlm.nih.gov/41213283/)
- Kdigo 2024 Clinical Practice Guideline For The Evaluation And Management Of Chronic Kidney Disease – (https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf)
Source-Medindia