Easy and affordable access to Peritoneal Dialysis under PMNDP facilitates ‘Living well with kidney disease’

1 in 10 people in India is said to be suffering from some form of chronic kidney disorder (CKD), of which 2,20,000 new cases of kidney failure (stage V CKD) are reported in India each year, severe enough to need dialysis. Chronic kidney disease is a severe public health problem so much so that kidney failure is projected to be the fifth leading cause of death worldwide by 2040! On this World Kidney Day, keeping in line with the theme of ‘Living Well with Kidney” it would be pertinent to spread the much required education and awareness on how patients suffering from kidney failurecan live a healthy life, maintain their role and social functioning, whilst maintaining some semblance of normality and a sense of control over their health and wellbeing.

One of the major hurdles for such patients is the lack of access to dialysis, which has long been a reality owing to critical shortages of dialysis equipment and staff especially during the COVID-19 pandemic. This has made the entire process even more challenging for them. However, the Indian government’s decision to include Peritoneal Dialysis (PD), an advanced and convenient technology for home-based dialysis treatmentunder the Pradhan Mantri National Dialysis Programme (PMNDP) in 2016 has been helping kidney failure patients to have affordable and easy access to this home-based treatment option. With the inclusion of PD in PMNDP, the government has broughtdown the overall cost of treatment by efficiently leveraging the resources, which in turn will help all the kidney failure patients to have easy access to the services.

‘‘Last year, the private insurance players brought in Peritoneal Dialysis under the ambit of the insurance policies. This decision by the private insurance sector will support the government’s vision to achieve affordable healthcare for all. At a time when we are still battling a pandemic situation, ensuring accessibility to affordable dialysis for kidney patients is the least that can be done. There are many people who are struggling to manage their expenses in pandemic times and any more monetary burden related to comorbidities such as kidney problems can make matters worse. In such a scenario, this extended support from private insurers of bringing in PD under their policies has been a great move,’’ Dr Arup Ratan Dutta, Director, Nephrology & Transplantation Fortis Hospital, Kolkata

PD frees patients from the multiple visits to the clinics every weekas applicable in the conventional Haemodialysis (HD) and can be performed at home without any specialized equipment. In fact, it can be easily carried out at home by the patient, often without help. Contrary to a HD session, PD is painless and needle-less procedure that allows the patient to lead a better quality of life even with the chronic ailment. Moreover, PD is suitable even for children below five years as it does not stop them from pursuing their school or other normal activities.

Ankit Ahujaa patient (name changed) said,‘‘A major barrier to a greater use of Peritoneal Dialysis (PD) in India is unawareness. Successful implementation of the therapy requires introducing it to the people who need dialysis thrice a week on urgent basis, providing adequate training to patients for using it safely at home and placing PD catheters and dialysate in timely manner. And while making these arrangements and PD accessible, elderly and the disabled groups should be prioritized. Pradhan Mantri National Dialysis Programme included PD in the national health mission policy in 2019 that provides dialysis free of cost to people below the poverty line and a minimal charge is applicable for other patients. However, only four states across India have implemented the policy so far’’

Nevertheless, private insurance companies’ latest decision of including PD under the ambit of insurance policies will help India in making renal care affordable for all. There is an increasing dialysis demand of 31 percent in the county. Including PD in insurance policies will act as a driving force for more people to opt home-based dialysis. This would prevent people from discontinuing the dialysis due to financial crunch. Today, about two-third of 70 to 80 percent kidney patients in India withdraw from dialysis and succumb to death due to financial crunch and around 60 million dialysis patients are pushed under the poverty line due to exorbitant medical bills.

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