India’s Kidney Wake-Up Call: Why Every Adult Over 20 May Need Kidney Tests Twice a Year
India’s kidney-care policy could be heading for a major reset. After years of expanding dialysis and transplantation facilities for patients with advanced kidney failure, a Parliamentary Standing Committee has called for a prevention-first approach - one that seeks to identify kidney damage much earlier and slow its progression before patients reach the point of needing lifelong kidney replacement therapy.
The Parliamentary Standing Committee on Health and Family Welfare has recommended mandatory kidney function tests (KFTs) every six months for everyone aged 20 and above, with annual screening for all high-risk individuals. It has proposed that the tests be provided free to people Below Poverty Line (BPL) and at a nominal cost to those Above Poverty Line (APL) under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD).
The recommendation is part of the committee’s 177th report, “Prevalence of Chronic Kidney Disease in India – Prevention, Diagnosis, Treatment and Management,” presented in the Rajya Sabha and laid before the Lok Sabha on August 7. Headed by Rajya Sabha member Ram Gopal Yadav, the panel has made 66 recommendations spanning prevention, early detection, diagnosis, treatment and long-term management of chronic kidney disease (CKD).
The urgency behind the proposal is clear. The committee cited a pooled CKD prevalence of about 13.24% in India and noted that nearly 2.2 lakh new patients with end-stage kidney disease are added every year. That translates into an additional requirement of roughly 3.4 crore dialysis sessions annually.
The scale of the crisis is also reflected in newer research. A 2025 Lancet analysis estimated that 138 million Indians aged 20 and above were living with CKD in 2023, placing India second globally behind China, which had an estimated 152 million cases. A 2026 Indian Journal of Medical Research analysis further examined the disease’s incidence, mortality and state-level disparities, underscoring the growing burden across the country.
From treating failure to preventing it
India has not ignored kidney disease. It has spent years building treatment capacity, particularly through the Pradhan Mantri National Dialysis Programme (PMNDP), launched in 2016. But the committee’s recommendations highlight the limitations of a system that increasingly has to manage patients after kidney function has already been severely lost.
The committee noted that haemodialysis sessions under the national programme have risen from about 25 lakh to 70 lakh in five years. The latest programme data also show the breadth of the infrastructure now in place, with dialysis services covering all States and Union Territories and hundreds of districts.
Yet dialysis can replace some functions of failed kidneys; it cannot restore damaged kidneys. This is why the committee wants India to shift resources and attention upstream - toward preventing progression to kidney failure.
The recommendation is especially relevant because CKD is often a silent disease. People may have substantial loss of kidney function without obvious symptoms. India's own CKD guidelines recognise that kidney disease can be identified through markers such as albuminuria and reduced GFR, while the clinical pathway incorporates serum creatinine and eGFR assessment.
Why the existing system is not enough
The committee has criticised the present approach to CKD screening as largely opportunistic. In practice, people are often tested when they visit Ayushman Arogya Mandirs or other health facilities rather than being systematically called for periodic kidney assessment.
That creates a major gap for high-risk populations.
The committee has therefore called for a national CKD screening protocol under NP-NCD, with standardized pathways across primary healthcare facilities. The principal high-risk groups include people with diabetes and hypertension, which together account for a major share of CKD cases.
The screening net would also cover adults above 60 years, people with a family history of kidney disease, obesity or tobacco use, and those with a history of acute kidney injury, recurrent urinary tract infections, recurrent kidney stones or prolonged exposure to potentially nephrotoxic medicines such as NSAIDs.
The proposal also marks an important age shift. Existing population-based NCD screening has largely focused on adults aged 30 and above, while the committee wants routine KFTs to begin at 20. That would represent a substantial expansion of kidney surveillance among younger adults.
A simple laboratory change could make a big difference
Perhaps the most immediately practical recommendation is the demand for automatic eGFR reporting.
The committee wants every serum creatinine test performed in public or private laboratories to automatically generate an eGFR result, preferably using the CKD-EPI equation, without a separate request or additional cost.
That matters because creatinine alone is not always sufficient to detect early kidney impairment. A person can have a creatinine value that appears within the conventional range despite a meaningful reduction in kidney function.
For high-risk individuals, the committee wants kidney assessment to include both eGFR and urine albumin/protein testing. This reflects the modern understanding that kidney health cannot be judged by filtration alone; albumin leakage is another important marker of kidney damage and future risk.
If implemented, automatic eGFR reporting could potentially improve detection without requiring an entirely new blood test every time creatinine is ordered.
Andhra Pradesh shows why one-size-fits-all screening may not work
The proposal becomes particularly significant in Andhra Pradesh, which is specifically identified for targeted CKD screening among agricultural and occupational populations affected by CKD of unknown etiology, or CKDu.
The Uddanam region of Srikakulam has long been recognised as an important CKDu hotspot. Research has found unusually high CKD prevalence in parts of the region, including among people without the traditional risk profile of diabetes and hypertension. One study involving 1,184 adults found CKD prevalence of 32.2%, with farming associated with a 20% higher prevalence after adjustment. The researchers stressed that occupational exposure could play a role, while noting that the causes require further longitudinal investigation.
This is why the committee’s mention of heat stress, recurrent dehydration and agrochemical exposure matters. These should be treated as possible contributors under investigation, rather than established single causes of CKDu.
Andhra Pradesh is also pursuing research into earlier detection. Uddanam has been the subject of studies involving blood, urine, environmental samples and potential biomarkers, reflecting a wider scientific effort to identify kidney damage before conventional clinical deterioration becomes obvious.
The region therefore offers an important lesson: a national kidney policy cannot focus only on diabetes and hypertension.
The infrastructure exists - but implementation is the challenge
The proposal is ambitious, but India is not starting from scratch. NP-NCD already provides an institutional platform for NCD screening, while the country has an extensive primary-care network and a growing digital health infrastructure.
The committee wants to build on that foundation through an integrated digital CKD framework under the Ayushman Bharat Digital Mission, with electronic referral pathways, longitudinal patient records and monitoring of high-risk individuals. It has also proposed a National CKD Registry.
At the same time, it has recommended strengthening nephrology services at district hospitals, improving specialist referrals and establishing a separate national programme for paediatric kidney care.
These measures reveal the committee’s central concern: screening alone is not enough.
If millions of people are tested, India must also have the capacity to interpret abnormal results, confirm disease, provide treatment and track patients over years. Otherwise, mass screening could produce a huge number of abnormal reports without necessarily reducing kidney failure.
Can the six-month KFT become reality?
For now, the answer is uncertain.
The Parliamentary Standing Committee’s recommendation is not yet a government-approved nationwide mandate. The Health Ministry will have to examine the recommendations and determine how they can be implemented, funded and integrated into existing programmes.
The report also does not propose a specific pilot project for six-monthly KFTs among all adults aged 20 and above. Existing targeted research and screening projects, including those in CKDu-affected areas, should not be confused with a formal pilot for this national proposal.
A phased approach could eventually prove more practical: first make automatic eGFR reporting routine; strengthen annual screening for diabetes, hypertension and other high-risk groups; intensify targeted screening in CKDu hotspots; connect abnormal results to digital referral systems; and then assess the cost-effectiveness and feasibility of broader population screening.
The ultimate test will not be whether India can collect millions of blood samples. It will be whether it can turn early detection into early intervention.
That is the real significance of the parliamentary recommendation. India has already built a large dialysis network to deal with kidney failure. The next challenge is to make that network less necessary by identifying disease before it reaches its irreversible stages.
With CKD affecting an estimated 138 million Indians, a reported prevalence of 13.24%, around 2.2 lakh new end-stage cases each year and an additional annual requirement of 3.4 crore dialysis sessions, prevention is no longer merely a desirable addition to kidney care.
It may be the only sustainable way to change the trajectory of India’s kidney crisis — from a country increasingly preparing to treat kidney failure to one determined to prevent millions from reaching it.