AIIMS Delhi Head of Nephrology Dr Dipankar Bhowmik urges hospitals to scale CKD screening and green dialysis
By Arunima Rajan
In an interaction with Arunima Rajan, Dr Dipankar Bhowmik, Head of Nephrology, AIIMS Delhi, says that to tackle CKD in India, we need to screen high-risk populations and encourage a healthy lifestyle among people.
World Kidney Day 2026 carries the theme “Kidney Health for All: Caring for People, Protecting the Planet.” India now has the second-highest number of chronic kidney disease (CKD) cases globally, with an estimated 138 million people affected. As someone who has led nephrology at AIIMS for decades, how would you assess where India stands today in tackling this silent epidemic, and what does this year’s theme mean for a country like ours?
The question is in two parts. With relation to the WKD theme, while providing Kidney Health for All, we need to protect the planet too. Both haemodialysis and peritoneal dialysis have a high carbon footprint. Green nephrology/dialysis is an important concept now gradually being implemented. For example, during haemodialysis, a large amount of water is rejected from the RO plant; this can be fruitfully used in toilets and agriculture.
To tackle the silent epidemic of CKD in India, two approaches are needed: a) screen high-risk populations like diabetics, hypertensives, obese individuals, patients with various chronic diseases, and pregnant women; b) for the general public, encourage a healthy lifestyle: plenty of fluids, low salt, low sugar, avoiding processed/packaged foods, regular exercise, maintaining ideal body weight, checking for accumulation of abdominal fat, and avoiding/reducing over-the-counter use of painkillers. Yearly BP, urine tests for proteinuria, and blood creatinine.
CKD is often called a “silent disease” because it progresses with few or no symptoms in its early stages. Despite the availability of simple, low-cost tests such as serum creatinine and routine urinalysis, many cases remain undetected. What systemic changes does India need to implement to make early screening and detection of kidney disease a public health priority?
Chronic kidney disease (CKD) is often termed a “silent disease” because it progresses with minimal or no symptoms in the early stages. This makes systematic screening at the primary care level critical. India needs to integrate simple, low-cost tests, such as serum creatinine and routine urine analysis for albumin/protein, into regular check-ups at primary healthcare clinics and community health centres, particularly for high-risk groups like patients with diabetes and hypertension.
Equally important is the sensitisation and training of primary care physicians (general practitioners) and physicians. Many patients first interact with the healthcare system through primary care providers, so improving their awareness and confidence in early CKD detection, and encouraging routine screening, can significantly increase timely diagnosis and referral.
Diabetes and hypertension remain the leading drivers of CKD worldwide, and India is dealing with a dual epidemic of both. From your clinical experience at AIIMS, how effectively are primary care physicians and general practitioners currently managing these risk factors to prevent downstream kidney damage, and where are the biggest gaps?
The gaps are significant. India has over 77 million people living with diabetes and nearly 220 million with hypertension, both major risk factors for CKD. However, studies suggest that CKD awareness among patients remains below 10%, and referral to nephrologists often occurs late, when kidney function has already significantly declined. Improving screening, physician sensitisation, and early referral pathways between primary care and nephrology services would therefore be key systemic steps in reducing CKD progression.
This year’s theme specifically highlights the environmental impact of kidney care. Haemodialysis is highly resource-intensive, consuming large volumes of water, significant energy, and substantial amounts of single-use plastics. How realistic is the concept of “Green Nephrology” or “Green Dialysis” in the Indian context, and what practical steps can dialysis centres take to reduce their environmental footprint?
The concept of “Green Nephrology” or “Green Dialysis” is becoming increasingly relevant in the Indian context. This is especially important since a large number of haemodialysis centres have now come up across the country, leading to a substantial environmental footprint. Haemodialysis is a resource-intensive therapy, and each session can consume up to 120-150 litres of water and generate around 1-2 kg of medical waste, much of which is single-use plastic.
In India, the idea of green dialysis is realistic if practical measures are adopted at the facility level. Dialysis centres can reduce their environmental footprint through water conservation and reuse systems, such as recycling reverse osmosis reject water. Greater awareness and adoption of sustainable practices across the growing network of dialysis centres could significantly reduce the environmental burden while maintaining quality patient care.
In India, nephrology expertise is heavily concentrated in metros and Tier-I cities, while CKD disproportionately affects vulnerable populations in underserved areas. What models of care, whether tele-nephrology, task-shifting, or hub-and-spoke systems, do you see as most promising for reaching kidney patients in rural and semi-urban India?
Tele-nephrology and the hub-and-spoke model are, and can be, very effective approaches for expanding access to kidney care in rural and semi-urban regions. Encouragingly, nephrology is increasingly becoming more well known, and with the availability of renal facilities in smaller towns, nephrologists are also now shifting there, which is gradually improving access to care. However, a major gap remains: India has an estimated 3,000-3,500 nephrologists for a population of over 1.4 billion, highlighting the need for innovative service delivery models. In this context, kidney education and sensitisation of physicians at the primary care level will also be very helpful in improving early detection, timely referral, and continuity of care.
AIIMS recently made headlines with a landmark dual kidney transplant, where both kidneys from a 78-year-old brain-dead donor were successfully transplanted into a single recipient, a procedure that your department helped pioneer. What does this tell us about the untapped potential in India’s organ donation ecosystem, and what policy or infrastructural changes could meaningfully expand the transplant programme?
At present, we are in dire need of more organs, and organ donation in many parts of the country, particularly in North India, is abysmally low. While innovative transplant approaches can help utilise available organs more effectively, the larger challenge remains increasing the overall donor pool. Addressing this gap will require sustained public awareness efforts, but equally important is the need for greater education and sensitisation within the medical profession, including better identification of potential brain-dead donors and timely counselling of families. Strengthening hospital-based transplant coordination systems, improving organ-sharing networks, and increasing awareness among both the public and healthcare professionals could meaningfully expand the transplant programme and help save many more lives.
Artificial intelligence and digital health tools are increasingly being explored for early CKD detection, risk stratification, and remote patient monitoring. From a practitioner’s standpoint, which technological interventions hold the most promise for nephrology in India, and what are the barriers to their widespread adoption?
From a practitioner’s standpoint, both telehealth and social media are powerful tools for improving kidney health awareness, patient education, and follow-up care. At the same time, AI is coming up in a big way in various kidney algorithms, especially for early CKD detection, risk stratification, and predicting disease progression.
Nephrology also relies heavily on pathology and radiology, and in both these branches, AI is increasingly being used to assist in image interpretation, biopsy analysis, and diagnostic decision-making. These technologies can help clinicians detect kidney disease earlier and manage patients more efficiently.
As President of the Delhi Nephrology Society and one of India’s most experienced nephrologists, if you could make one policy recommendation to the Government of India on World Kidney Day 2026, what would it be? And what is your message to the general public about protecting their kidneys?
Currently, kidney diseases account for the ninth leading cause of death in India. While chronic kidney disease (CKD) has only recently been included among the important non-communicable diseases (NCDs) in national health discussions, there is a strong need for a more focused strategy. In my view, CKD must have a separate national prevention programme, with emphasis on early screening, risk-factor control, especially diabetes and hypertension, and strengthening kidney care services at the primary healthcare level.
For the general public, the message is simple: regular health check-ups, control of blood pressure and diabetes, maintaining a healthy lifestyle, and avoiding unnecessary medications can go a long way in protecting kidney health.
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