Kidney failure occurs due to a variety of reasons and can largely be grouped into two types – those that are completely reversible (acute) and those that are not (chronic). The chronic disease eventually progresses to end stage when the only treatment options are dialysis or kidney transplantation, the latter being the preferred option. Both these modalities of treatment are very expensive and hence, prevention of kidney disease is of utmost importance.
Efforts to prevent kidney disease include early detection and treatment. This has to be done on a mass scale involving the community at large – just a simple urine test and BP measurement done annually can detect not just kidney disease in the very early stage, but also its two main causes namely diabetes and high blood pressure. Also, educating the public about early reporting of symptoms like appearance of blood in the urine and swelling of feet is vital. This is the only and most cost-effective way of winning over this ‘epidemic’ of kidney failure, which is already reaching gigantic proportions drawing the attention of policy makers, which is reflected in the recent central government budget.
In India, over 2 lakh new cases of end stage kidney disease present each year. Of these, about 70 percent manage to get access to dialysis treatment, but almost two-thirds of these give up because of they cannot afford it and unavailability of treatment. So, one-and-a-half lakh patients just perish while the rest continue dialysis treatment awaiting kidney transplant. Chronic dialysis is virtually non-existent in the government-run hospitals and unaffordable in the private sector – costs Rs15,000 to 20,000 per month.
The government has taken steps to alleviate this problem to some extent. The Rajiv Gandhi Aryogya Yojana provides free dialysis in designated private and charitable hospitals to patients who are below poverty line. A few states notably Andhra Pradesh and Telangana provide dialysis in the government hospitals under PPP. The central government has revoked the custom duty and other taxes on the dialysis equipment and the dialysis components. This is a great decision for which the nephrology community had been lobbying for almost a decade.
The government has also announced “National Dialysis Services Programme” to be started under the National Health Mission through PPP model. This is a giant step. To get access to these funds the state governments are expected to follow a few stringent policies in the tendering process. These policies are made mandatory to guard against any financial irregularities and to ensure that the funds reach the patients. Insurance industry and various reimbursement schemes are also helping the patients get access to dialysis treatment.
Quality of dialysis is another issue. Dialysis unlike most other treatments needs intense efforts to maintain quality of care including infection control. Many dialysis centers are ill-equipped to ensure this quality of care – particularly in smaller cities and towns. Fortunately, dialysis industry is changing fast. The entry of dialysis chains like Apex Kidney Care, Davita and B Braun has brought in protocol driven practices and accountability thus improving the standard of treatment. These chains have the potential to make quality dialysis available in the small towns across the country.
All said and done, the best treatment is kidney transplant. Not all are fortunate to have a fit and willing kidney donor in the family, leaving most to stay on dialysis and await their turn for a deceased donor kidney. There are 1,800 patients waiting for kidney transplant on the waiting list in Mumbai alone. Most of them die waiting as only 50-60 deceased donor transplants are performed annually. A big effort is being done to increase the donor pool by innovations like swap transplant and domino transplants by registries like Apex Swap Transplant Registry (ASTRA). Thanks to the great efforts of the media, awareness about organ donation and transplant is increasing fast.
The situation is much better than what it used to be a decade ago and is fast improving. A large planned effort is needed towards early detection and prevention of kidney diseases as our country cannot afford its treatment costs.
The author is a consultant nephrologist at Bombay Hospital