The Looming Threat: Addressing Kidney Failure
The pandemic brought to our attention, the looming shortage of infrastructure to address some of the most critical healthcare cases. But pandemic is not our only threat. Non-communicable diseases continue to put millions at risk with Kidney Failure still emerging still taking 2.2 Lakh new patients in its ambit, raising the dialysis demand to 3.4 crores. Lack of awareness on the subject, for decades, has put millions at an added risk. On World Kidney Day, it is time to sharpen the message on kidney disease awareness, underline the need to widen the treatment choices for patients, and look at the future with policies that propel the cause by making treatments accessible.
Understanding Chronic Kidney Disease: An Insight
Our kidneys have millions of tiny blood filtering units called nephrons. Once they are damaged, functioning of our kidney goes down. A progressive loss in kidney function is called chronic kidney disease or CKD. The damage continues gradually for months or over a span of years as more and more nephrons stop working and are not able to filter the blood. When kidneys stop functioning beyond a point of repair, it is called kidney failure. Now, the challenging part about the disease is that in many cases CKD comes with no signs or symptoms, and when undetected, CKD can lead to a progressive loss of kidney function, eventually resulting in advanced kidney failure (also called end-stage renal disease, ESRD).
While there is no cure for chronic kidney disease, various treatments can halt its progress, and help a patient lead a better life. In the case of kidney failure, patients need dialysis for the removal of excess waste from their blood. Dialysis partly replaces kidneys excretory function when they can no longer work. There are two types of dialysis— done by machine, called haemodialysis and done by using a patient’s abdomen as a natural filter, called peritoneal dialysis (PD). While most patients go for haemodialysis, PD has helped patients lead a better lifestyle over the years as it can be done at home and helps people go about their daily activities without many challenges.
The Knowledge Gap: The Case for Peritoneal Dialysis
While PD can be conducted at home, haemodialysis involves frequent visits to the hospital. In a in a country like ours, with roughly 4950 dialysis centres, with a major share with the private sector, the demand for dialysis is not half met.Haemodialysis services under National Dialysis Programme is currently available at district hospital level in 444 Districts in 765 Centres by deploying 4471 machines. However, patient have to bear invisible expenses like travelling to the dialysis centre, losing daily wages of the caregiver and so on that makes the treatment unbearable for many, especially those living in rural areas with restricted access to these facilities.
Now, an important question here is— when PD is an option that can help save costs and access, why does India have only 6,500 patients on PD?
The reasons are many. To begin with, there is a lack of awareness about the option. Patients do not know how they can benefit from PD, and some of them are sceptical about conducting it on their own at home. Many patients feel that the set-up at home is complicated. It is quite simple. Patients just need to see the doctor for a pre-dialysis set up to place a soft plastic tube called catheter into the abdomen by surgery. High cost of PD supplies is another roadblock to the underutilization of this home-based dialysis method. If India is to make healthcare accessible for its people, we need policies that encourage people to take up treatments like PD by making them affordable.
The Future of Kidney Care
“Prevention is the best cure”, early detection of kidney disease, creating public awareness and screening high risk population can significantly prevent kidney disease. When the patients reach End stage kidney disease patient education, empowerment and equitable access to dialysis modality can significantly improve patients’ quality of life. We need to factor our own strengths and limitations and device a strategy to optimally provide renal replacement therapy to our population. There are lessons to learn from around the world. Countries likeThailand, for instance, have adopted a dialysis programme primarily based on PD after evaluating the cost, technologies, and outcomes. Today, they offer PD as the default dialysis modality (barring exceptions based on certain health concerns). India needs policies to provide equitable access to PD to help people reap the benefits of this treatment.
In addition, we also need to identify strategies and resources that help patients manage stress while seeking the treatment. Kidney failure can be traumatic for patients. We must look at strategies to facilitate therapy sessions to support families and caregivers as well. It is important to understand that knowledge is empowerment when we are fighting a disease burden. Fortunately, today, we have multiple sources of information with websites like dedicated to information on kidney diseases. It is time to help patients make informed decisions by encouraging them to learn better and control their condition. This World Kidney Day, we must pledge to help patients with kidney disease ‘live well’.
