Influence of Medical and Non-Medical Determinants that affect living in Healthy Volunteers.

INTRODUCTION : The chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence and hence an increasing number of patient are treated with renal replacement therapy —dialysis or transplantation. The annual incidence of ESRD has doubled over the past decade to reach about 135 per million in Europe and similar rate in USA. It is expected to continue to rise at an annual rate of around 5–8%. In India, the annual incidence is 34–240 per million population38. Two factors are important. The first is the ageing of the population; the incidence of ESRD is higher in elderly people than in the general population. The second factor is the global epidemic of type 2 diabetes mellitus; the number of people with diabetes worldwide (currently about 154 million) is predicted to double within the next 20 years. And in India as per the diabetes atlas 2006 published by the diabetes federation , the number of diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive measures are taken. And with it there is an expected parallel epidemic of diabetic nephropathy. AIM : To evaluate the patients with chronic kidney disease stage 5 (CKD 5) and their prospective renal transplant donors regarding: 1. The renal replacement choices made by the patients with CKD 5. 2. To assess the medical and non-medical factors that affect living related renal donor selection among prospective renal transplant recipient. METHODS : Over 24 months, consecutive patients with CKD 5 and their relatives were interviewed at their presentation to the nephrology services of Christian Medical College, Vellore, and the reasons for the choice of modality chosen were analyzed and the prospective recipient and their donors were again interviewed separately and the medical and non medical factors that affected the donor selection were determined. RESULTS : 1257 consecutive CKD 5 patients were enrolled over 24 months. Conservative, dialytic treatment and renal transplantation were chosen by 513 (40.8%), 320 (25.5%) and 424 (33.7%) patients. Only socioeconomic status affected significantly the modality chosen and not the age, gender or donor availability. Patients or donor were likely to withdraw from transplant evaluation commonly due to absence of voluntary donor , presence of a male donor, coercion not to donate and absence of sponsorship either fully or partly. The commonest cause of rejection of a donor was ABO incompatibility (45.8%), followed by diabetes mellitus (DM) or risk of DM (24%), renal disease (5.9%), hypertension (5.5) and persistent cross match positivity (5.1). CONCLUSION : The non medical factors that negatively influences the donor availability or withdrawal should be identified and to improve the rates of organ donation