Today, with an increased focus on healthcare, there’s been observed a growing demand for care related to kidney diseases and associated injuries. This trend is primarily driven by an aging population, longer life expectancy and a rising incidence and prevalence of kidney-related conditions. These factors highlight the urgent need for nephrology services, a trend anticipated to persist in the foreseeable future. Among the distinguished nephrologists contributing to the advancement of kidney healthcare in the country is Dr DK Agarwal, a Senior Nephrologist at Apollo Hospitals in New Delhi.

The Professional Venture
Dr Agarwal comes from a humble background, his father worked as a postman and owned a small plot of farmland. He began his education in Ukharra, Agra, and later gained admission to S. N. Medical College in Agra after successfully passing the UP entrance examination. After completing his MBBS degree, he pursued an MD (Medicine) and subsequently obtained both DM & DNB (Nephrology). He also holds MAMS (Nephrology), FICP, FISN and FAMS (Fellow of American Society of Nephrology).

Initially, he was interested in cardiology, but eventually, he decided to join the field of nephrology. Dr DK Agarwal says, “At that time, I thought nephrology was a promising area because dialysis was just beginning to gain traction, particularly with efforts from figures like Jayaprakash Narayan and M. K. Karunanidhi. Then, kidney transplants were emerging as a treatment option. Given these developments, I chose to focus on nephrology”.

Holding 32 years of experience, Dr DK Agarwal is one of the most eminent Nephrologists in Delhi NCR, specializing in Renal Transplant, hemodialysis, CAPD and all kidney-related ailments along with critical kidney patients with emergency management. Throughout his career, Dr Agarwal has worked with various prestigious institutions, including the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI) in Lucknow and Nizam’s Institute of Medical Sciences (NIMS) in Panjagutta, Hyderabad. He spent several years there, but due to his family’s circumstances, he eventually returned to Uttar Pradesh and continued his work at SGPGI, Lucknow.

For the past 25 years, he has served as a senior consultant in Nephrology and Renal Transplantation at Indraprastha Apollo Hospitals. Additionally, he has been involved in teaching DNB Nephrology students for nearly 20 to 25 years and has held the position of Academic Coordinator for the DNB Nephrology program for the past 15 years. Each year, three students got a specialization in Nephrology, and many of whom are now making significant contributions across various parts of the country. They are actively engaged in clinical practice, performing transplants, dialysis, and managing cases in clinical nephrology.

Dr DK Agarwal says, “Being a Nephrologist, amongst the various challenges to overcome, transplantation itself presents critical challenges, especially in achieving optimal outcomes while preventing rejections and infections. Striking a balance in immunosuppression is crucial to maintain graft survival and minimizing infection risks. In India, infections like tuberculosis pose a serious threat, leading to patient deaths even when kidney function is stable. Next, managing HIV patients is another challenge. I have taken a particular interest in this area and successfully treated over 30 patients with dialysis and transplants when few others wouldn’t. This effort has made a significant impact in providing care to both international and domestic patients. Lastly, disease prevention through early intervention and patient education is essential”.

He adds, “During consultations, I typically spend about 5 to 10 minutes to guide patients on medication use, diet control and potential challenges. The alarming prevalence of self-medication in India often leads individuals to buy medications without proper advice, increasing the strain on their kidneys and contributing to the rising incidence of kidney failure and chronic kidney disease (CKD)”.

Notably, University of Missouri, Columbia, U.S., SGPGI, Lucknow and NIMS, Hyderabad did provide a great exposure to his practice. During his time in Missouri, he noticed the emergence of several CAPD (Continuous Ambulatory Peritoneal Dialysis) programs, which were not as prominent in India at that time. Now, the Nephrologists handle everything domestically, whether it’s CAPD, transplant procedures, or all forms of hemodialysis. He learned the importance of using medications judiciously there, as they focus on prescribing only what is necessary rather than multiple drugs. This careful approach to medication, along with the availability of newer technologies in India have transformed the Nephrology practices.

Dr DK Agarwal emphasizes the importance of regularly reviewing journals, reports, and research papers, as well as attending both international and domestic conferences, to stay updated and developed new treatment approaches

Dr DK Agarwal’s teaching experience includes institutions like Apollo and SGPGI. He believes that Nephrology is not an isolated branch, rather, it is deeply connected to general medicine. Hence, commitment to accurate diagnosis, thorough patient evaluations, and continual learning are key to being an effective nephrologist, especially with advancements in the field of hemodialysis and renal transplant.

The Commitment to Keep Up with Advancements
Staying updated in the medical field is crucial due to ongoing developments. Recent advancements have notably impacted transplantation and nephrology, especially in immunosuppression with new drugs like ATG, Rituximab, and monoclonal antibodies. Dialysis practices have improved as well, with high-flux dialyzers and Hemodiafiltration (HDF) is now standard, alongside the evolution of Continuous Ambulatory Peritoneal Dialysis (CAPD) to include Nocturnal Intermittent Peritoneal Dialysis (NIPD) for home use. ABO-incompatible transplants have been performed for over 15-20 years, and techniques to clear antibodies for transplantation have been developed. Nowadays, HIV-positive patients are getting renal transplantation successfully with results on par with those of HIV negative patients.

Today, a wealth of information is available through various media, and Dr DK Agarwal too emphasizes on reviewing journals, reports & research papers regularly, attending conferences, both internationally and in India to stay updated. This practice helps one to gain insights and develop new treatment approaches.

Keynotes for Aspiring Leaders
As an advice to the upcoming healthcare leaders, he says, “Our commitment to patients is significant, considering the socioeconomic challenges in the country. We must consider patients from all backgrounds, and provide unbiased opinions and assistance, especially to those less fortunate. Also, staying informed about new developments is essential for improving patient care”. Lastly, he adds, “Our parents are like Gods and we should provide due care & regard to them”.

Awards & Recognition:
•Awarded Distinguished Clinical Tutor by Indraprastha Apollo Hospital, New Delhi
•Awarded Indefinitely Honorary Professor by Ministry of Health,
Republic of Uzbekistan
•Felicitated by his holiness Dalai Lama for his excellent work in the field of Renal Transplantation