‘Medical Mystery’ in Andhra Village; study confirms high deaths due to kidney ailments

Pawan Kalyan, the Tollywood power star and Jana Sena Party Chief did a hunger strike and highlighted the unusually high incidence of Chronic Kidney Disease (CKD) in Uddanam region of Srikakulam district of Andhra Pradesh five years ago.

He alleged that over 20,000 people, both young and old had succumbed to this problem over the years. The Jana Sena leader demanded that the then Chief Minister, N Chandrababu Naidu should act promptly to help the people and control the disease.

Pawan Kalyan said, lakhs were affected with this chronic kidney disease known as ‘Uddanam Nephropathy’ and alleged that successive governments could not address this issue effectively.

After a lull when all seemed to have forgotten a new study by The Sydney, Australia headquartered George Institute for Global Health has confirmed that CKD is indeed the leading  cause of deaths in Uddanam, Andhra Pradesh, India.

Loss of kidney function

CKD leads to a gradual loss of kidney function in the person, which in turn impacts the overall health. The group of researchers from the Institute’s India facility in Delhi have shown that the age and sex-adjusted prevalence of CKD in this area is estimated at 18-22%, which is  2.5 to 3.3 times higher than the population prevalence of CKD reported from other regions of India.

 Previous reports in the lay press have highlighted a large burden of deaths due to CKD in Uddanam, but to date, there has been no study with formal ascertainment of causes of death in the region, the Institute claimed.

According to Prof Vivekanand Jha, Executive Director, George Institute of Global Health, India and lead researcher of the study : “The research has revealed that chronic illness is not only a health problem but also the main cause of death in Uddanam. To prevent and manage CKD and increase community awareness of early diagnosis and treatment, we are working closely with the district and state health authorities to develop and implement region-specific policies that will improve the outcomes of these patients. The government has increased access to diagnosis and evidence-based treatment for kidney diseases which will likely translate into improved outcomes.”

Research methodoly

The population-representative study was published on October 31, 2023 in the Kidney International Report Journal. The study used the Smart Verbal Autopsy (SmartVA) tool that uses a computerized algorithm to interpret data from interviews with surviving family members or caregivers of deceased individuals.

The tool has been validated by the Population Health Metrics and Research Consortium under various settings. It uses a predefined set of questions to collect data regarding the indications, symptoms, and cause of death. The study used the adult deaths module of SmartVA, offering a systematic and automated approach to identify the probable cause of death for individuals aged 12 and older.

The study analysed a general population sample of 2,419 individuals in Uddanam from 2018 to 2022. It clearly demonstrates the extent to which CKD impacts the people of the Uddanam region in Andhra Pradesh, it said.

Key findings

• 1.    Significantly, 45% of all recorded deaths in Uddanam region were due to CKD, making it the leading cause of mortality.
• 2.    The higher death rate among adults above 20 years suggest a major problem. The death rate is ten times higher than reported in national surveys.
• 3.    The study revealed that it poses a considerable health risk to the community. The finding has important implications for resource allocation and public health policy.
• 4.      The study emphasizes the importance of developing targeted methods for early detection, diagnosis, and treatment and urges the mobilization of resources and public health initiatives to combat CKD in the region. Other study members included Dr Balaji Gummidi, Dr. Vaishali Gautam, Dr Renu John, Dr. Rohina Joshi, and Dr Oommen John.

The back story

Uddanam, a hardly known place in Srikakulam district of Andhra Pradesh had climbed into the charts of ‘medical mysteries’, with international attention over a decade ago.

The Telugu Desam Government set up three dialysis units as a knee jerk response to the problem getting into public domain. Pawan Kalyan had urged the government to immediately set up a research centre to find out the reasons for high incidence of kidney ailments.

The state government tried to wash its hands off by starting only three dialysis centres, the actor-turned politician criticised. The mystery deaths of Uddanam got highlighted about a decade in medical circles.

According to reports from the WHO, the causes for the high incidence remain elusive despite a few studies. However, the mortality rate is high among the farming community as of now.

Globally, similar instances of Uddanam nephropathy have been reported from Sri Lanka, China, Belgium and a few other regions in the last two decades.

Scientists are grappling with the issue. Incidentally, in 2018, a team from Harvard University Medical School visited Uddanam region to study the causes of high number of kidney-related diseases and deaths. Uddanam covers five mandals—Kaviti, Sompeta, Mandasa, Ichapuram and Vajrapukotturu, covering nearly 100 villages.