Introduction

CKD is major public health concern worldwide with regard to number of individuals affected and therapeutic costs involved. In India, given its population being more than 1 billion, the rising incidence of CKD is likely to pose major problems for healthcare and the economy in future years. The prevalence of CKD in SEEK-India cohort was found to be 17.2%.^[1] Chronic Kidney Disease encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR).^[2] Initially it manifests only as a biochemical abnormality. Eventually, loss of the excretory, metabolic and endocrine function of the kidney leads to the development of the clinical symptoms and signs of renal failure which are referred to as uraemia. Diabetes mellitus is the most common cause of chronic kidney disease.

There is no direct link of chronic kidney disease to any of the Vyadhi explain in Ayurvedic text. The diseases can be studied as provoked Dosha, specific causes, and their sites.^[3] Good knowledge of Vikara Prakarti (state of vitiated Dosha, Dhatu, and Mala which causing the disease), Adhishthanantarani (site of vitiated Dosha) and Samutthana Vishesha (cause of vitiation of Dosha) is important for Nidana and Chikitsa.^[4]

Prameha acts as a Nidanarthakar Roga for CKD. The symptoms and signs of chronic kidney disease (CKD) mainly reflect an imbalance in the Vata and Kapha Doshas, along with disturbances across multiple Doshas.^[5] Initially, there is a disruption in Rasa, Rakta, Mutra, and Udaka followed by involvement of all Dhatus and Upadhatus. Here the derangement in the Dosha is exhibited in the form of an abnormality in the definite Dhatu pattern.^[6] Each Dhatu has its typical embedded structural and functional qualities. Transformation during pathogenesis brings some structural and functional disturbances in a normal constitution of a Dhatu and reflects specific characters.^[7] This typical abnormal condition of a Dhatu is referred as Dhatu Dushti.^[8] Ayurveda considers Dhatu Dushti as a critical aspect which is estimated to be leading the disease pathogenesis as well as prognosis. While explaining Dosha Dushti, Hemadri in Ayurveda Rasayana Tika on Ashtang Hrudaya explain Types of Dushti.

For each sign or symptom, grading was done and scores allotted.^[10] On the basis of total score obtained, the subjects were divided into Mild, Moderate and severe Rasa Dhatu Vruddhi, Kshaya and Dushti Lakshanas.

Methods of selection of study subjects

Diabetic patients of chronic kidney disease on dialysis irrespective of religion from study centre are selected on the basis of patients’ blood report. Sr Creatinine, Blood Urea, eGFR, Stage of CKD.

Inclusion Criteria

1. Patients of Age group 30-70 year
2. Both Gender
3. Diabetic patients of chronic kidney disease on dialysis.

Exclusion Criteria

1. Patients not on Dialysis.
2. Patients of Chronic Kidney Disease suffering from any cause other than Diabetes.

Observation Parameters

1. Subjective Parameters:

It includes Assessment of Rasa Dhatu Kshaya, Dhatu Vruddhi and Dhatu Dushti by Number of Lakshanas.

2. Objective Parameters:

It includes Blood investigations. Objective parameters, Serum Creatinine and Blood Urea were collected from patients’ blood report and eGFR were calculated from age and Serum Creatinine and gender. From the eGFR, Stage of CKD were calculated.

Observations and Results

Table 1: Observation Gradation

Distribution of Patients as per Gender

Out of 220 patients enrolled in study, there were 145 males & 75 females. 94% of both females & males have Rasa Dhatu Dushti as per prevalence.

There are 26 (12%) patients in Stage 4, 192 (87%) patients in Stage 5, and 2 (1%) patients in Stage 3b. In total, there are 220 patients. This means most patients are in Stage 5, a few are in Stage 4, and very few are in Stage 3b.

Prevalence across Rasa Dhatu

Table 2: Prevalence across Rasa Dhatu

Rasa Dhatu show the highest prevalence of abnormalities in all metrics (Rasa Kshaya, Vruddhi and Dushti > 90%) in diabetic patients of CKD on dialysis.

Distribution of Patients having more than 50% Lakshanas across the Stages:

Table 3: Distribution of Patients having more than 50% Lakshanas across the Stages

Figure 4: Distribution of Patients having more than 50% Lakshanas across the Stages

More than 50 % of Rasa Kshaya Lakshanas were observed in 71 patients out of 220, Rasa Vruddhi Lakshanas were observed in 40 patients out of 220 and Rasa Dushti Lakshanas were observed in 7 patients out of 220. Rasa Kshayatmaka Dushti predominantly present in diabetic CKD patients on dialysis.

More than 50 % of Rasa Kshaya Lakshanas were observed in 59 patients out of 71 in Stage 5, 11 in Stage 4 and 1 in stage 3b. Stage wise also, Rasa Kshayatmaka Dushti is predominantly present in diabetic CKD patients on dialysis.

Figure 6: Prevalence of Lakshanas Across CKD Stages

In stage 3b, the earliest stage assessed in this study, Rasa Dhatu showed 100% prevalence for all three types of imbalances, Kshaya, Vruddhi and Dushti indicating that disturbances in Rasa Dhatu are among the earliest and most consistent features in CKD progression. In stage 4 CKD, the prevalence of imbalances intensified. Rasa Dhatu disturbances remained prominent, with Vruddhi and Dushti reaching 100% where as Kshaya affects 96.2% of the patients. At stage 5 CKD, the most advanced in the dataset, the pattern of widespread Rasa Dhatu imbalance continued. Rasa Dushti was present in 92.7% of patients, and Rasa Kshaya and Vruddhi both exceeded 95%, reinforcing the critical role of Rasa Dhatu pathology in advanced CKD. These findings indicate that Rasa Dhatu Kshaya, Vruddhi and Dushti remain highly prevalent across all CKD stages, with a slight decline in Rasa Dushti from Stage 4 to Stage 5.

Discussion

From descriptive statistics of Dhatu Lakshanas, it is observed that Rasa Kshaya and Rasa Vruddhi Lakshanas are mild to moderately present while Rasa Dushti Lakshanas shows both severity and occurrence in diabetic CKD patients on dialysis.

Lakshanas of Rasa Kshaya, Vruddhi and Dushti are found in more or less proportion in a single patient of CKD. This is due to vitiation of Dosha as per Hetu and Sthan^[11] which vitiate the Rasa Dhatu. For example, Prakupit Vata (by its Ruksha Guna) vitiate the Rasa Dhatu and causes Raukshya Lakshan which is a Rasa Dhatu Kshaya Lakshana. In the same patient Vruddhi of (Kledak) Kapha at Amashaya may cause Agni Mandya which is a sign of Rasa Dhatu Vruddhi similarly in same patient Arasadyata, sign of Rasa (Dushyatmak) Dushti is observed due to vitiation of (Bodhak) Kapha at Jivha.