Better National Dialysis Infrastructure: Need of the hour

Kidney Disease and Children - Act Early to Prevent It' is the theme for this year's World Kidney Day. Dialysis is the last option and can be avoided.

Kidney Disease and Children - Act Early to Prevent It' is the theme for this year's World Kidney Day. Dialysis is the last option and can be avoided.
Kidney Disease and Children - Act Early to Prevent It' is the theme for this year's World Kidney Day. Dialysis is the last option and can be avoided.

Second Thursday of every March is considered as World Kidney Day… Dialysis is a last stage option & prevention should be the goal.

[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]T[/dropcap]he kidneys in the human body are designed for multi tasking.  The two bean shaped organs, remove waste products  from the blood, release blood pressure regulating hormones, control production of red blood cells, balance the body’s fluids, and produce an active form of vitamin D which is vital for strong and healthy bones.

Like all good workers, they go on working without complaining, and its only towards the end, when they can take it no longer, that the symptoms of an issue appear, by which time it’s too late to nurture them back to good health.

Severe Kidney ailments are classified into Acute Kidney injury (AKI) or Chronic Kidney Ailments (CKD).

AKI is generally reversible and caused by events like dehydration, loss of blood during surgery, use of medications, snake bite, etc.

[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]C[/dropcap]KD develops over a period of time wherein kidneys functions are affected, main cause being unregulated diabetes or high blood pressure.  CKD are measured in stages depending on the Glomerular Filtration Rates (GMR). The fifth and final stage is End Stage Kidney Failure or End Stage Renal Disease.  Symptoms of CKD may not develop until very less kidney functions remain.

Dialysis (filtration of blood) is essential at this stage. An average of three sittings, of four hours each, is required every week. The alternative to dialysis is kidney transplantation. One can lead a healthy life with one kidney also.

There are two kinds of dialysis. In hemodialysis, blood is pumped out of the body to an artificial kidney machine, and returned to the body by tubes that connect one to the machine. In peritoneal dialysis, the inside lining of one’s own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of one’s belly in cycles.

[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]F[/dropcap]or most patients in India (and many other countries), once advised dialysis, (and it is hemodialysis that we are talking about), the writing in the wall is clear.  The family resources will be exhausted, the small ‘help’ from various charitable trusts and well wishers will be over, and ‘Yamraj’ steps in. Many families give up within a few months.  Needless to say with resources exhausted, the families are also ‘finished’.

CKD is a reality staring at us. It is going to escalate in future. The announcement by the Union Finance Minister, Shri Arun Jaitley, during his budget presentation for 2016-17, has to be understood against this backdrop.

Jaitley stated “about 2.2 lakh new patients of End Stage Renal Disease get added in India every year resulting in additional demand for 3.4 crore dialysis sessions. With approximately 4,950 dialysis centres in India, largely in the private sector and concentrated in the major towns, the demand is only half met. Every dialysis session costs about ₹2,000 – an annual expenditure of more than ₹3 lakh”.

[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]J[/dropcap]aitley also said that in addition to the costs, most families have to undertake frequent trips, often over long distances, to access dialysis services, incurring heavy travel costs and loss of wages.

The above are numbers getting added every year, in addition to those already under dialysis.

The government action plan was spelt out by Jaitley who announced that “To address this situation, I propose to start a ‘National Dialysis Services Programme’. Funds will be made available through PPP (Public-private partnership) mode under the National Health Mission, to provide dialysis services in all district hospitals. To reduce the cost, I propose to exempt certain parts of dialysis equipment from basic customs duty, excise/CVD (Countervailing duty and SAD (Special Additional Duty)”.

[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]T[/dropcap]he intent to address the problem, albeit in a small way is commendable. It is not clear as to how much of the gap will be covered. The model for the PPP, we may come to know in course of time. In India there does not seem to be much penetration for ‘health care services’ under the PPP model. This will be a benchmark.

The success will help to extend to other areas under ‘health care services’ also.  The model will have to factor into, the requirements and pricing to various economic strata of society.  The PPP model will help government to focus on policy making. The expertise and best practices from private sector can be used for improving public health.

It had been reported in the press that IIT-Bombay was developing a solution to cut down costs and time of dialysis significantly.

[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]A[/dropcap]s mentioned earlier, persons with diabetes and hypertension are more susceptible to kidney ailments.  It has been reported that India is on its way to be the ‘diabetes capital of the world’. So the population who will need ‘dialysis or kidney transplantation’ may go up.

Prevention is better than cure. Some of the suggestions, as understood literature on the subject are,

  1. Take regular medications to keep diabetes and/or hyper-tension under control.
  2. Go for your regular walk (or cycling, swimming) and follow regular regimen. Do not under estimate the power of Yoga, meditation, surya namaskar, beat stress.
  3. Reduce intake of salt and sugar.
  4. Do not self medicate. Certain Non steroidal anti-inflammatory drugs (NSAIDs) are known to increase risk of kidney damage.
  5. For the susceptible class, regular blood /urine tests and medical check-up to be done
  6. Reduce intake of processed foods.
  7. Tobacco consumption /smoking to be eliminated.

Truly ‘Good Health is Wealth’. Let us all work to retain this wealth.

(This is not meant to be medical advice, but intended to create awareness on CKD and urgency for maintaining a healthy lifestyle)


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