Kidney Care Beyond Curiosity: The SKIMS Nephrology Journey. Akram Sidiqui

Kidney Care Beyond Curiosity: 

The SKIMS Nephrology Journey

Akram Sidiqui

sidiquirayan@gmail.com 

Chronic kidney disease (CKD) has emerged as one of the most pressing health challenges in Kashmir, silently gripping thousands across both rural and urban communities. 

Recent studies reveal alarming trends, in a regional screening of 2,222 individuals (mean age 44.5 years), 2.2 % were found to have CKD, while nearly 8 % had a glomerular filtration rate below 60 ml/min, signalling compromised kidney function. Nationally too, the age-standardised prevalence of CKD in India has risen by 5.6 % between 1990 and 2017, with Kashmir showing an even sharper local surge. 

Rising hypertension, diabetes, recurrent infections, and unsafe analgesic use remain key drivers. At the heart of the region’s response stands the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, which provides advanced dialysis, transplant services, and extensive screening and awareness programs, becoming a lifeline for thousands and a beacon of hope in countering this mounting nephrological crisis in the Himalayan region.

In a region where distance can mean death and snowstorms can delay ambulances by days, the emergence of a full-fledged nephrology department at SKIMS is not just a medical development,  it is a moral imperative.

Before its rise, patients with kidney failure or severe renal disorders faced a cruel choice: travel hundreds of miles to Delhi or Chandigarh, or slowly fade at home. Dialysis was scarce, nephrologists fewer still, and transplant options , almost nonexistent.

Then SKIMS, with its academic foresight, kindled the flame of change. A team of dedicated physicians, nurses, and technicians began building the department brick by brick, establishing regular dialysis schedules, creating specialized renal units, and introducing advanced diagnostic facilities. Slowly but decisively, the department became the only tertiary referral centre for kidney diseases in Jammu & Kashmir, commanding respect across northern India by performing almost 335 transplants form 2015 to 2024. while as the landmark swap kidney transplant add many more feathers to the glaring cap of SKIMS.

First Swap Transplant: SKIMS performed its first swap kidney transplant in December 2023.

Second Swap Transplant: A second swap kidney transplant was successfully performed in August 2024. 

This procedure involved two incompatible pairs of donors and recipients who exchanged kidneys.

It was a dream come true as the first of its kind  dialysis center  ( peritonial dialysis ) in SKIMS was established in late eighties.  Now the  rhythmic hum of dialysis machines is almost symphonic, a music of life returning drop by drop. The department’s acute and maintenance dialysis units now function round the clock, providing thousands of sessions each month.

Patients with acute renal failure caused by infections, postpartum complications, or metabolic disorders are managed with immediacy that rivals any metropolitan centre.

Behind this efficiency lies an unsung network , sterile water treatment plants, trained technicians, dedicated nursing cadres, and vigilant infection control. The department’s dialysis facilities adhere to the same protocols used at premier national institutions, ensuring both safety and sustainability.

For the common Kashmiri patient ,a farmer, a labourer, a teacher from Kupwara or Pahalgam , this access has meant something profound.

No doubt dialysis sustains life but  transplantation the final option in hand,  transforms a limping life to normal levels.

A decade ago, renal transplantation in the valley was spoken of with reverence and fear, a near-mythical medical event only few could access. But the last ten years at SKIMS have rewritten that narrative into a story of triumph.

Between 2014 and 2024, SKIMS has carried out hundreds of kidney transplants each one a testament to surgical brilliance, patient faith, and institutional will.

In December 2023, SKIMS performed its first swap (paired-donor) kidney transplant, a landmark achievement that required sophisticated immunological matching, ethical clearance, and multidisciplinary orchestration.

The feat placed SKIMS among the select few Indian institutions capable of conducting such complex procedures , a milestone that glittered not just on hospital records but in the hearts of all who had laboured for it.

The transplant program today boasts state-of-the-art theatres, immunology laboratories, post-transplant ICUs, and a regimented follow-up system. Donors and recipients are evaluated through advanced cross-matching techniques, and post-operative care is handled with precision that reflects global best practices.

Numbers alone tell only part of the story. Each transplant is a parable of courage.

A mother donating to her son from Baramulla; a brother giving life to a sister from Pulwama; a husband repaying love through sacrifice , these are the everyday epics that unfold quietly at SKIMS.

“The most sacred moment,” says a transplant surgeon, “is not when the new kidney begins to function, but when hope itself begins to flow again.”

The Nephrology Department at SKIMS is more than a centre of treatment; it is a living laboratory of learning. Research here reflects both local reality and global relevance.

From studies on infection patterns in transplant recipients to analyses of chronic kidney disease linked to lifestyle and altitude, SKIMS’s nephrology research is carving a distinctive niche.

The institute’s Journal of Medical Sciences (JMS SKIMS) regularly features work from the department, highlighting findings that resonate beyond Kashmir, such as the prevalence of glomerulonephritis, biochemical predictors of graft survival, and the unique challenges of dialysis in high-altitude climates.

By engaging in these studies, SKIMS offers the medical community data from a population often absent in mainstream literature, those living between mountains, where healthcare delivery dances with geography.

This commitment to academic pursuit situates SKIMS alongside reputed centres like PGIMER Chandigarh, AIIMS New Delhi, and CMC Vellore , not merely in facilities but in the intellectual spirit of inquiry.

Today, the Department of Nephrology at SKIMS stands shoulder to shoulder with India’s leading institutions. Its infrastructure is comprehensive and contemporary:

Dedicated Dialysis Blocks for acute and chronic cases, equipped with advanced machines, double RO water purification, and high-efficiency filters.

Renal Biopsy and Interventional Nephrology Services, including peritoneal dialysis, AV fistula creation, and catheter-based access care. Integrated Infection Control Systems that meet NABH-equivalent standards.

Multidisciplinary Transplant Boards involving nephrologists, urologists, immunologists, social workers, and ethicists.

Patient Counselling Units that guide families through the emotional labyrinth of donation and recovery.

Digital Record Systems and Follow-up Clinics ensuring graft monitoring and medication compliance. Beyond technology, what truly parallels SKIMS with national institutes is its philosophy of care, a union of science and service. Here, medicine is not mechanistic; it is mindful.

A defining moment in the department’s history came when SKIMS performed the first kidney transplant under the Ayushman Bharat PM-JAY scheme in Jammu & Kashmir. This bold step placed the promise of transplantation within reach of economically vulnerable patients, proving that modern medicine, when guided by ethics, can bridge social divides.

By aligning its programme with national insurance policies, SKIMS has created a model of inclusive healthcare, where advanced procedures are not a privilege of the affluent but a right of every citizen.

As a deemed medical university, SKIMS carries the dual flame of treatment and teaching. The Department of Nephrology has become a crucible for training future nephrologists, dialysis technologists, and transplant nurses.

Workshops, CMEs, and grand rounds on renal transplantation draw participants from across North India. Each academic exercise here is not merely about protocol but about philosophy, to see in every nephron, a microcosm of life’s tenacity.

The department’s collaboration with the Multidisciplinary Research Unit (MRU) has opened vistas for molecular studies on renal pathology, genomics of transplant rejection, and epidemiological mapping of kidney disease in the Himalayan belt.

But the fact of the matter is that the department still grapples with organ shortage, donor hesitancy, and logistical hurdles in ensuring post-transplant follow-up for patients from far-flung districts.

Deceased-donor programmes are nascent, and public awareness remains a pressing need.

However, initiatives in telemedicine, donor counselling, and awareness campaigns are slowly thawing these challenges, promising a more vibrant future for organ donation in the valley. What endures in the corridors of SKIMS is not the hum of machines but the quiet faith of its healers.

Doctors who spend nights by the bedsides of transplant recipients; nurses who become surrogate family for months; social workers who travel to distant villages to trace potential donors ,this is where the science of nephrology dissolves into the art of humanity.

Looking forward, SKIMS envisions a fully digital renal registry, advanced immunology laboratories, and an expanded Deceased Donor Programme. Plans are afoot for telehealth integration with district hospitals, ensuring follow-up for patients in remote valleys who often miss post-transplant visits during winters.

Collaborations with national networks like NOTTO and the Indian Society of Nephrology are being strengthened to ensure standardization and continuous professional development.

As the department steps into its fifth decade, it carries not just experience but purpose, to make kidney care accessible, ethical, and exemplary across the Himalayas.

To walk through the Nephrology wing of SKIMS is to witness more than medicine,  it is to glimpse the resilience of a region personified through a department.

Here, in the gentle hum of machines and the quiet diligence of clinicians, beats the pulse of a people determined to heal themselves.

The department’s journey from modest dialysis units to performing hundreds of sophisticated transplants stands as a metaphor for Kashmir itself, resilient, resourceful, and radiant in the face of odds.

The Nephrology Department at SKIMS has not merely treated kidneys; it has restored dignity, rebuilt families, and redefined hope for the Himalayan populace.

Its doctors are not just specialists, they are custodians of a covenant, healers whose work speaks the language of rivers, flowing silently but ceaselessly toward life.

In the valley where rivers remember glaciers, SKIMS Nephrology stands as another stream of knowledge, care, and continuity. Every dialysis drop, every transplant incision, every research paper from its laboratories is an ode to survival ,to life reclaimed, rewritten, and renewed.

And as the evening light fades over Soura’s skyline, SKIMS Nephrology department remains abuzz with activitis of attendents of patients along with workholic doctors  preparing for the dawn of next day so that one more agonised soul affilicted with  kidney disease is relieved off and given a new lease of life

Long Live SKIMS