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Peritoneal Dialysis Is The Safer Way Forward For Kidney Patients As They Face The Brunt During COVID-19 Pandemic

Kidney diseases are often associated with cases of catastrophic expenditure in developing countries like India.

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Prevention and treatment services for Chronic Kidney Disease (CKD) patients have been severely disrupted because of the prevalence of COVID-19. According to a recent report by WHO, patients suffering from NCDs such as hypertension, cancer and diabetes who require blood transfusion are at higher risk of contracting COVID-19-related illnesses and deaths.

People living with NCDs are at higher risk of severe COVID 19-related illness and deaths. 1 This ever-increasing number of COVID-19 positive cases have instilled a sense of fear in dialysis patients that they might contract the deadly virus. Patients visit these dialysis centre thrice a week, covering long distances which leads to the added burden on their pockets. For patients in rural areas, travelling long distances to get the treatment, these costs are not only impacting their household expenditure, but also making them more vulnerable to the other diseases.

Rama (name changed on request) suffering from CKD usually visits the hospital for his dialysis sessions every few days. What might be considered a taxing routine anyway became worse when the hospital he used to visit had to shut down its dialysis unit after someone tested positive for Covid-19. Patients like Rama are compelled to visit hospitals frequently to be hooked up to a machine for four hours per dialysis session. Having a compromised immune system puts them at an increased risk of falling prey to COVID-19.

Similar closures and lack of transportation amid the pandemic, and the nationwide lockdown to contain the spread of the deadly virus, have raised questions about the fate of those suffering from ESRD, an ailment which adds about 2.2 Lakh new patients in India resulting in additional demand for 3.4 crore dialysis every year, even without the problems that the COVID-19 crisis has unleashed.

Therefore, it is about time that India considers home-based dialysis or Peritoneal Dialysis (PD) as an alternative treatment method. Better access to PD would potentially mitigate the substantial non-medical costs associated with travel and lost productivity to attend haemodialysis units. PD is a cost-effective therapy that allows therapeutic intervention at home.

Why is Peritoneal Dialysis need of the hour?

Kidney diseases are often associated with cases of catastrophic expenditure in developing countries like India. The crippling long-term expenditure faced by 0.2 million Indians who require 34 million dialysis sessions in total every year, gradually slide these patients into deep poverty. 2 Dialysis demand in India is growing at a rate of 31 percent, compared to six percent in the United States and eight percent in the rest of the world. 3 Even though most of the CKD patients start dialysis, financial crunch compels about two-thirds of them to withdraw and succumb to death. Dialysis costs three to four lakhs annually.

The therapy does not require close medical supervision, making it a viable and feasible alternative to manage dialysis staying indoors during the pandemic. It is a painless therapy as it does not require vascular access or needling. If offers greater freedom and flexibility in the treatment schedule of a patient, as it can also be carried while sleeping. It involves minimum complications and fewer dietary restrictions.

Managing Chronic Kidney Disease With PD

The kidneys are responsible for filtering waste and excess fluid from the blood as urine. chronic kidney disease causes the kidneys to lose their function over time. Kidneys of people who suffer from the disease, function below 10 percent. There is no cure for the diseases, however, one can manage symptoms by considering the best treatment options available. Depending on how severe the symptoms are, treatments like medicines, dialysis and kidney transplants are recommended by the doctor.

PD can be carried by the patient in a clean, private place including home, work or even when travelling, offering a greater flexibility. To filter the blood inside the body, it uses the lining of the abdomen or belly. A surgeon places a soft tube, called a catheter in the abdomen of the patient, a few weeks before they start PD. When the treatment starts, dialysate which is the solution with salt and other additives, flows from a bag through the catheter into the patient’s belly. When the bag is empty, it needs to be disconnected and a cap is placed on the catheter. While the dialysis solution is inside the belly, it absorbs wastes and extra fluid from the body.

Before undergoing dialysis at home, one should maintain adequate hygiene and wash hands to reduce the risk of infection. It is strictly advisable to drain used dialysate in the flush. PD will enable timely access to care and prevent thousands of households from falling into poverty due to chronic kidney disease each year. While making it accessible to all, the elderly and the disabled groups should be targeted first. Even though Pradhan Mantri National Dialysis Program (PMNDP) has included PD in the national health mission policy that provides dialysis free of cost to people below the poverty line, there is still a dire need to ensure that the policy is implemented pan India in order to provide better accessibility and quality healthcare in these trying times. With the implementation of the policy, private medical insurance companies should also include the CAPD treatment under their medical cover so that it can benefit the patients at large.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.

Dr. Sunil Prakash

Director & Head, Nephrology and Renal Transplant Service, BLK Superspeciality Hospital, New Delhi

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