Introduction:
According to the International Society of Nephrology, some form of kidney disease afflicts more than 850 million people, a number that is rapidly increasing every year. Chronic kidney disease (CKD) involves a slow and progressive deterioration of the kidneys’ ability to cleanse the body of harmful substances and fluids. There has been a growth in the ever-higher ranking of CKD among the leading cause of deaths between 1990 and 2016 (Naghavi, et al, 2017). The global prevalence of CKD increased by 33% between 1990 and 2017 (Francis, et al, 2024). With approximately 10% of the world’s population living with CKD, it is currently the third fastest-growing major cause of death worldwide (ibid.). CKD is projected to become the world’s fifth leading cause of death by 2040, and yet, kidney disease is the most neglected chronic disease (Luyckx, et al 2021).
Methods:
CKD is a major public health challenge as it places a large and increasing burden on society, which is unequally shared; a burden that can be alleviated by upstream strategies aiming to address social determinants of health, but are not put in place (Schoolwerth, et al, 2006). The purpose of our article is to provide a comprehensive review of the literature on the social determinants of CKD in India. This review will be a springboard for a meta-analysis of existing empirical findings as well as an original empirical analysis.
Results:
Our starting point is that there are definite medical risk factors of CKD and its progression in rural India, which need further investigations. A range of communicable and noncommunicable diseases result in renal complications (Luyckx, et al, 2018). Scarcity of clean and accessible water supply and sanitation, causing water-borne and diarrhoeal illnesses are major causes of acute kidney injury (AKI), not only through pre-renal states from dehydration, but also glomerular pathological processes from certain parasitic infections like schistosomiasis. This is another significant, but mitigable cause of CKD. The use of nephrotoxic remedies (herbal medications, aminoglycoside antibiotics, non-steroidal anti-inflammatory drugs, etc.), exposure to nephrotoxic agents (heavy metals, agrochemicals, venom, etc.), inadequate maternal nutrition, incidence of low birth weight and preterm birth, obesity and diabetes are major medical risk factors (ibid.).
Conclusions:
The impacts of the medical risk factors are mediated or compounded by social risk factors, which can be categorized as social determinants of CKD. These fall into 4 broad categories of processes that are related to: the workplace (outdoors and indoors), living place (e.g. physical infrastructure including parks, walking paths, etc.), anthropogenic physical environmental changes, including global warming, inadequate access to healthcare, and economic-social background of CKD patients or those vulnerable to CKD. All of these social determinants of CKD are a function of the nature of market-state relations – in particular, how the market operates, including the corporatization of healthcare, and the role of the government in relation to access to healthcare, occupational health, ecology, income, and social inequalities.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.