For 65-year-old Rima, frequent hospital visits for dialysis for four hours per session was already quite frustrating. And now, over-crowded hospitals with COVID-19 positive cases have instilled a sense of fear in her that she might contract the virus. But six months ago, when she was introduced to home-based dialysis or Peritoneal Dialysis (PD), her life changed overnight.
“After I started carrying dialysis at home, my quality of life improved. I have fewer dietary restrictions and during the process, I can roam around the house and do activities as per my convenience.”
In the extension of the nationwide lockdown to contain the COVID-19 situation, patients who are suffering from non-communicable diseases such as end-stage renal disease (ESRD) are finding it hard to cope with their condition. India has approximately 4,950 dialysis centres facing a staff crunch in the wake of the pandemic outbreak. Life regularly hangs in balance for Rima and the other 2 lakh Indians who require 34 million dialysis sessions in total every year and the status quo has added to their woes. Every dialysis has an additional expenditure every month resulting to Rs 3-4 lakhs rupees annually. Most families undertake 2-3 visits to dialysis centres every week. They cover long distances that incur heavy travel costs and loss of wages for the patient and family member accompanying them. Keeping this in mind, using PD is a cost-effective therapy that allows convenient therapeutic intervention at home.
Moreover, for most PD cases close medical supervision is not required, making it a viable alternative for patients on dialysis to manage their disease staying indoors during the pandemic. Young children below five years are also suitable for PD as it makes their lifestyle flexible, including schooling and other activities.
Learning from global counterparts
Many countries around the world have introduced certain changes to increase the implementation of PD as it can be operated at lower costs in the healthcare system. In 2008, Thailand adopted a PD-first approach as its universal health coverage scheme in which dialysis is provided for free if the patient is treated with PD. China, Taiwan, Vietnam, New Zealand, Australia, United States, among others have seen an unprecedented expansion in the use of PD. In the US, the use increased so rapidly that there was a shortage of dialysate supply in 2014.
How does peritoneal dialysis work?
A surgeon places a soft tube called a catheter in the patient’s body, a few weeks before PD is started. When the treatment starts, dialysis solution of water with salt and other additives, flows from a bag through the catheter into the belly. When the bag is empty, it needs to be disconnected and one can place a cap on the catheter so that they can move around and carry normal activities. While the dialysis solution is inside the belly, it absorbs wastes and extra fluid from the body. The solution and the wastes are drained out of the belly into the empty bag after a few hours. The procedure is started again with a fresh bag of dialysis solution. Dialysis is not a cure for kidney failure; however, it can help a patient feel better and live longer.
Things to keep in mind while undergoing peritoneal dialysis
- To avoid missing dialysis exchange, there is a need to ensure timely delivery of supplies
- Used dialysis bags and tubes should be properly disposed in a sealed bag. Drain used dialysis fluid in the flush
- The patient and a family member who is helping the patient carry PD at home, should maintain adequate hygiene and wash hands frequently to reduce the risk of infection as much as possible
Successful implementation of PD across the country requires the ability of introducing the therapy to people who need dialysis on urgent basis, placing PD catheters in timely manner and adequate training to patients for using it safely at home. The elderly and the disabled groups should be targeted first while making PD accessible to all. While PMNDP has included PD in the national health mission policy, however, the need of the hour is to facilitate PD pan India to manage the burgeoning number of kidney patients, especially in times of COVID-19. Right suggestions and treatment by the doctors at the right time can save the lives of the infected people who are battling between life and death.
Dr R. Balasubramaniyam is Chief Nephrologist, Kauvery Hospital, Chennai