Published Sep 24, 2026 | 7:00 AM ⚊ Updated Sep 24, 2026 | 7:00 AM
Patients often failed to connect their symptoms to kidney disease.
Synopsis: A study conducted in Andhra Pradesh found that 58% of newly diagnosed CKD patients reached tertiary care late, often due to poor awareness, missed follow-ups, financial constraints and limited healthcare access. Patients also reported difficulty understanding test reports and inadequate communication with doctors—highlighting multiple barriers to timely kidney care.
An AIIMS, Mangalagiri, study found that more than half of newly diagnosed chronic kidney disease (CKD) patients in Andhra Pradesh reached hospitals only after the disease had advanced.
Researchers surveyed 200 patients and held focus group discussions to understand the delay in seeking medical care.
The study, published in the Indian Journal of Nephrology, found that 116 out of 200 patients, or 58%, sought medical assistance late.
Doctors defined late presentation as reaching stage G4 or G5, the advanced stages of chronic kidney disease, under the 2024
Kidney Disease — Improving Global Outcomes (KDIGO) guidelines, the international standard for diagnosing and managing kidney disease.
Kidney function would have dropped sharply by the G4 or G5 stage.
Researchers conducted the study at a tertiary hospital in Guntur district over January and February 2024. They enrolled patients newly diagnosed or diagnosed within the previous month, and excluded anyone under 18, anyone with end-stage kidney disease, and transplant recipients.
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Patients often failed to connect their symptoms to kidney disease. One participant described chasing a heart diagnosis before doctors found the real problem.
“I do not know. The symptoms are related to the kidney. I was having shortness of breath; I went for a consultation for a heart problem. Then they told me I have a kidney disease. Until then, I did not have any kidney-related difficulty,” the participant said.
Another patient linked the gap directly to awareness. “If we know the symptoms are related to kidney problems, we will go to the hospital.”
The numbers back this pattern. Only 53.4% of patients with delayed presentation knew the long-term outlook of their disease, against 71.4% among patients who reached care earlier. Only 37.1% of the delayed group knew the names and uses of medicines, compared with 53.6% among the rest.
The gap widened around lab reports. Only 26.7% of patients who presented late said they understood their test results, against 47.6% of patients who did not delay. Researchers called this the largest gap in the whole survey.
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Cost shaped decisions throughout the study. Patients weighed hospital visits against wages—and wages often won.
“The hospital is too far from my home, and every visit means losing a day’s wage along with paying hospital bills. And when I don’t have any symptoms, I feel like there’s no need to take treatment or go for follow-up,” one participant said.
Another patient made the same justification to discontinue medication. “When I started feeling better, I assumed I didn’t need the tablets anymore. Travelling to the hospital also costs me a day’s wages, so I stopped going,” the participant said.
The quantitative data revealed that 6.9% of participants named financial reasons for skipping care. But the focus group discussions suggested higher numbers, since cost shaped decisions about follow-up even among patients who never labelled it a financial barrier.
Age deepened the problem for some patients living without support. “Financial constraints play a significant role, particularly among elderly individuals who do not receive adequate care or support from their children,” one participant said.
Another patient, living alone, put it starkly: “Somehow, we need to die someday. Why move here and there?”
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Several participants described turning to Ayurveda or other remedies before returning to allopathy, often on a neighbour’s word rather than a doctor’s.
“When my health started getting worse, we decided to try Ayurveda after our neighbours strongly recommended it. They said the condition would improve within three days,” one participant said.
Researchers noted that trust drove this decision as much as belief. Patients leaned on a neighbour’s account of what worked, and on a sense that hospital care cost more and demanded more.
The claims followed patients even after they returned to allopathic treatment. “Many non-allopathic practitioners claim they can cure kidney problems without dialysis or a transplant. Why don’t allopathic doctors give that kind of reassurance?” one participant asked.
Another patient pointed to a gap in doctors’ guidance on combining treatments. “The Ayurvedic doctors tell us it’s okay to take both their medicines and allopathic ones together. But allopathic doctors don’t say anything like that. They don’t guide us on whether we can combine treatments or not,” the participant said.
In the survey, only 3% of participants reported depending on alternative medicine. Researchers said the qualitative interviews tell a fuller story: many patients tried such treatments first, then shifted to allopathic care once symptoms worsened. This explained the low numbers in the survey.
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Communication between doctors and patients came up repeatedly in the discussions. Patients described leaving consultations with medicines but without explanations.
“Nowadays, doctors do not explain the patient’s condition. They prescribe medications, and the attendant gives instructions on when to take them, without explaining why the disease occurred, what precautions to take, or what to eat,” one participant said.
Confusion over how long to continue treatment pushed some patients to question follow-up visits altogether.
“The doctors did not specify the duration for taking the medications. We kept returning for follow-ups and were repeatedly prescribed the same medicines. Still, without knowing how long to continue, we started questioning the need for follow-ups,” another participant said.
The combined analysis found that 4.3% of delayed presentations were tied directly to poor communication with physicians, while 22.4% of patients neglected referrals and 11.2% skipped follow-up care.
Researchers said the findings showed that delayed CKD care cannot rest on individual behaviour alone. Health literacy interacts with family circumstances, access to care, communication gaps and wider beliefs about medicine.
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Researchers pointed to Andhra Pradesh’s rural regions, known for high rates of kidney disease. They named Uddanam in Srikakulam district, where doctors have documented chronic kidney disease of unknown cause for years.
The state has rolled out the STOP-CKD campaign, reverse osmosis water schemes, and dedicated kidney care centres. The Rajiv Aarogyasri programme has expanded free haemodialysis in government hospitals since 2007. Even so, researchers said gaps in access and early detection remain across the state.
CKD affects an estimated 13.8% of India’s population, with diabetes and hypertension driving most cases. Late diagnosis narrows treatment options, raises healthcare costs, adds complications and lowers quality of life for patients.
Also Read: Andhra’s poor battle diabetes, Telangana’s poor turn to alcohol
The authors said the fix cannot stop at telling patients to arrive earlier. They called for CKD awareness campaigns, family involvement, and a bigger role for Accredited Social Health Activists (ASHAs) in spotting cases early.
They also recommended screening through Primary Health Centres, tele-nephrology services to reach patients outside cities, and training for physicians on how to communicate a CKD diagnosis. Dialysis services, they said, must become cheaper and easily accessible, especially in regions where kidney disease runs high.
The researchers noted limits to their findings. The study covered one tertiary hospital in Andhra Pradesh, so results may not apply everywhere in India. Its cross-sectional design also means it cannot prove that any single factor caused the delay, only that the factors appeared together.
Even with those limits, the authors said the pattern held a clear message: patients did not arrive late because they ignored their health. They arrived late because awareness, family support, cost, and communication weren’t aligned at the right moment.
(Edited by Majnu Babu).
