The KIDNEY is an important organ of the body that performs many vital functions. Failure to treat several diseases, such as hypertension, diabetes, heart problems, obesity, kidney stones, or indiscriminate drug consumption will end up in kidney failure or chronic kidney disease (CKD). This is something scary.

Even in developed countries such as the United States, 16 percent of the adult population suffers from the disease, with 52 percent of deaths from cardiovascular disease (Foley RN, 2003). By projecting the prevalence rates in the US, it is estimated that more than 24 million Indonesians currently suffer from CKD, which is divided into three categories: mild, moderate, and severe.

For most people, the thought of doing hemodialysis or dialysis on a regular basis is a scary thing, especially when it comes to the cost. Sadly, the development of such expensive technology has not reduced mortality.

On the other hand, advances in medical and pharmaceutical technology have spent very large investments, among others, for research and development (R & D). Because the state is not able to handle everything, this role is taken over by the private sector, the medical equipment and pharmaceutical industries. This investment burden is in turn passed on to the patient. Therefore, treatment for chronic kidney disease, especially in the late stages, is expensive.

In the end, CKD patients who are able to enjoy treatment services with the latest technology are only the wealthy patients. Routine dialysis, for example, is impossible for the poor to undergo, except with state subsidies.

Therefore, a more comprehensive approach is needed. The target is not only to reduce the mortality rate of patients with chronic kidney failure, but also to reduce the chance of developing chronic kidney disease in people who have not been affected. Unfortunately, preventive medicine and community medicine approaches tend to be abandoned, perhaps being considered less attractive.

Currently, more resources are spent on the treatment of acute illness (delaying death with a poor quality of life). Unfortunately, this condition is perpetuated by the medical education system in universities and education in hospitals.

The prevalence of any disease, including chronic kidney disease, should be viewed as a failure to address socio-economic problems. No single disease is caused by a single cause. Although it involves biological agents and processes, chronic kidney disease cannot be separated from its social setting. CKD is an excess of social problems.

Nowadays, people are increasingly fond of eating salty food. To be healthy, a person only needs 3-4 grams of salt a day. More than that amount, the sodium salt will overwhelm the kidneys to respond and result in an increase in blood pressure. If this condition continues without stopping, the effect will accelerate the occurrence of chronic kidney failure and lead to frightening dialysis (hemodialysis).

Increases in income result in poorer diets, including targeting the vulnerable generation, the children. In addition to liking salt, people are also getting used to ingesting low-fiber foods. They are also increasingly fond of foods high in sugar and carbohydrates. The industry is flooded with snack products, almost all of which contain excessive sugar, salt, and carbohydrates. Foreign fast food restaurant chains quickly penetrate strategic locations in each city. Similarly, there is a the rush of energy drinks, high in calories, and carbonated. All can be said to "torture" the kidneys.

Supported by tantalizing audio-visual advertisements, advertisements eith seductive beautiful girls and macho men, and aired non-stop on television, the culture of public consumption has become shifted. By eating junk food fried chicken, drinking “very manly” energy drinks, or snacking on savory chips, people who are mentally inferior and foreign-minded feel they have experienced an increase in social status. Now, rural residents have also been infected with such social disease like this.

This lifestyle change fosters a new culture, namely the habit and pleasure of consuming foods and beverages that contain substances that have the potential to trigger kidney damage. Just imagine, in an advertisement on television, the male macho actor firmly said, "Wonderful, every day I drink xxx, my energy grows even more!" Of course the actor would be even more surprised if years later his kidneys (and of those who followed him) would be damaged. Even crazier, there is a live TV show that shows a greedy competition. Whoever devours the most food, until he almost vomits, is the winner. It is very surprising that such primitive program is able to pass broadcast by the Indonesian Broadcasting Commission.

This greedy consumption that triggers kidney and other organ damage is not an individual decision, but a social product engineered by the giant food and beverage industry and is supported by weak (even non-existent) state control. The medical factor with all its super-expensive technology seems to only play a role as a "firefighter".

Therefore, the introduction of a socio-economic environment that has the potential to trigger the number of patients with kidney failure and then reforming it with firmness in state policy is a realistic strategy, not difficult to implement, and low in cost. Let us “migrate” and launch a new paradigm: towards the prevention-based health.

Djoko Santoso
Excerpt from the oration in the inauguration as Professor at Faculty of Medicine,  Universitas Airlangga, Surabaya on Saturday, 18 January 2014

Translated from:
“Mencegah Penyiksaan Ginjal Masal”
Jawa Pos, Saturday, 18 January 2014