Across India, there is a growing burden of non-communicable diseases like diabetes, cardiovascular and chronic respiratory disease, which is the cause of severe ailments and premature deaths. Chronic kidney disease (CKD) is responsible for the poor health outcomes of these non-communicable diseases such as cardiovascular mortality, diabetes and hypertension.
Besides, if CKD, also known as chronic renal disease, is not addressed in patients on time, it leads to kidney failure and deaths. The overall magnitude of Chronic Kidney Disease is high. Every year, about 206,900 cases of CKD are reported and the numbers are expected to rise to about 2.2 million cases.
Among the most affected areas where CKD is widespread are in rural areas. Families have no provision of basic amenities like safe drinking water and sanitation, as well as health care and treatment is not available, which exposes them to infections and diseases like eye infections, cholera, typhoid, diarrhoea and hepatitis. Since these communities are located far away from the mainstream, the other challenge they face is poor access to heath care since the cost of renal replacement therapy in CKD patients is enormous which these impoverished communities are unable to provide.
For appropriate treatment and care for those afflicted by the CKD, dialysis is required. However, in these rural areas in states like Jharkhand, dialysis and other health care facilities are not available for these neglected groups.
In order to provide adequate health care and treatment for CKD infections in these rural areas, the government needs to provide Dialysis facility to Primary Health Care centres located at the villages and at the District level so that every affected patient can access treatment on time, which will help improve their health status.
According to Dr Vivekanand Jha, Executive Director, George Institute for Global Health India, and Professor of Nephrology at University of Oxford, since dialysis plays an important role in boosting the kidneys function, it should be provided at the household level in rural areas as well to ensure that those patients suffering from kidney ailments and are marginalised can get appropriate treatment on time so that their health status can improve and they can survive.
To ensure better results and health care support for those who have chronic kidney disease, the health ministry’s has announced that the State will provide National Dialysis Service for Chronic Kidney Disease patients. This treatment will provide free or highly subsidized treatment to patients who are suffering from end-stage kidney failure. This measure will go a long way to help those people who cannot afford the healthcare expenditure since dialysis so far has been highly expensive.
However, this service focuses on haemodialysis (HD), while neglecting other options such as kidney transplantation, and peritoneal dialysis (PD), since it is cheaper for the healthcare system and can also be done at home. Therefore it is the preferred treatment modality for state-funded dialysis programmes.
It is estimated that about 68,970 dialysis machines will be needed to treat 206,900 patients in the very first year across states. However, the numbers are expected to rise to a staggering 1.4 to 2.2 million cases.
A well-designed national service that reaches the unreached would be the best way to start. Since small HD units are unviable in remote areas, a different strategy is required to provide heathcare for these communities who reside there such as they should be offered PD which is viable for these groups.
Overall, dialysis consumables are expensive. In particular, the high costs of PD fluid bags which are enormously high. To address it, these can be produced locally which will not only cost less, it will also ensure that they are available for the public.
Besides, other health care should also be given to patients who need kidney transplant surgery and post-transplant immunosuppression. Those who cannot afford to get the transplant done because of financial problems, need to be supported by providing free treatment in the same way that dialysis is available for free.
Along with dialysis services, patients with multiple comorbidities, especially among the elderly, should be given palliative care services otherwise they will not be an improvement in their quality of health and life. Palliative care helps bring relief in the symptoms as well as overall health status.
Currently, every state needs to prioritize the need to provide dialysis services. Patients should be identified and given adequate treatment through dialysis.
According to the government’s data, the country has about 1.2 nephrologists for every million people, which unfortunately proves that there is enormous shortage of health care officials. The gap will take at least 25 years to fill if Indian training programmes produce nephrologists at current rates. The other challenge is that there is lack of trained nurses and technicians.
The terms of payment to the private dialysis provider need to be carefully thought out. The focus should be based on not only meeting the requirements related to process but should also take into consideration, the outcome parameters in order to provide comprehensive care and treatment.
Currently, data from the existing public dialysis schemes suggests that despite the increase in coverage, dialysis quality remains uncertain, and survival is suboptimal.
Instead of depending on providers, who often charge high cost for dialysis and also at times compromises the quality of treatment, the way for payments should be done by the state level academic organisations, with the focus on the process of treatment as well as outcome measures especially because along with chronic kidney disease, patients also report co-morbidity such as anaemia which also needs to be addressed, which will also be included in the overall dialysis cost.
Given how expensive dialysis currently is, a countrywide programme to identify and treat earlier stages of kidney disease so that advanced disease can be prevented must be developed.
Such strategies will prevent patients from struggling with this chronic disease and will provide appropriate treatment and care, especially in communities who have so far been neglected. The government across all States needs to provide not only adequate support but also ensure that along with chronic kidney disease, other infectious ailments are also addressed in order to save lives and build immunity in the afflicted people.
Mohuya Chaudhuri is a senior journalist and researcher