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Multiple barriers stalling efforts to reduce CKD burden in India despite innovative technologies: Experts

Despite the availability of new technologies, experts say that multiple barriers, such as ensuring the quality of dialysis, out-of-pocket expenses, and ensuring high-quality water for home dialysis are preventing the country from reducing the burden of chronic kidney disease.

During a panel discussion, organised on the occasion of the Kidney Health Summit organised by the IHW Council, experts from across the country emphasised investing in innovation in technologies directed towards popularising preventive measures.

Eminent nephrologists from across the country convened on March 13, 2023, for a summit jointly sponsored by the Apollo Hospital Group and Dr Reddy's Laboratories.

Dr Siddini Vishwanath, HOD & Consultant Nephrologist at Manipal Hospital, Bangalore, highlighted the role of innovative technologies in providing quality dialysis care, stating that most innovations should focus on the screening programme of detecting kidney diseases early so that further kidney damage can be arrested.
Because many dialysis facilities are opening in smaller towns and cities, innovations must focus on maintaining good water quality.
"We cannot take any chances with water quality because it is the lifeline, and any deficiency can lead to infections, which can increase the disease burden," he said.

Pointing out that hemodiafiltration is progressively being used across the country, in which Kolkata has taken the lead, Dr Vishwanath said that the technology is even better than that of haemodialysis, as it enables the healthcare providers to filter out the middle molecules, including β2-microglobulins which causes several issues like itching and lesion on the skin.

Dr Vishwanath described hemodiafiltration as a 'very-good' innovation, adding, "Many European countries have adopted it, but for some reason, the United States has not."

“In many cases, we have seen that those not doing very well with haemodialysis respond very well to hemodiafiltration, resulting in longer survival, with cardiac benefits, lesser hospital admissions, improvement in mortality and improved quality of life,” he added.

“This is something short of doing a transplant,” he stressed.

“This innovation has helped us to prolong the lives of the patients, and reduce disease burden, especially people who have cardiac issues, itching and skin lesions for which hemodiafiltration is doing well,” he added.

Pointing out that in recent times nephrologists are using many new filters apart from bigger dialysers have filters similar to plasmapheresis, Dr Vishwanath said, “We use these once a week or month to reduce middle molecules, which helps in reducing skin lesions and skin itching.”

Responding to the barriers to providing seamless dialysis treatment Prof Arpita Roy Chowdhury at the Department of nephrology at the Institute Of Post Graduate Medical Education & Research-SSKM hospital said that despite the best efforts of the government in extending health infrastructure accessibility deep in the country, various socio-economic factors are acting as a barrier.

“Through Pradhan Mantri National Dialysis Program  (PMNDP) we have extended dialysis to almost all the districts,” she said, stressing that in larger districts, there is more than one unit available.

“Still, the studies reveal that there is  a significant dropout in the population seeking dialysis,” Dr Roy Chowdhury pointed out

“So despite offering free dialysis, free medicine, and thinking that the people from the low socio-economic population will turn up to pick up the advantage, the numbers are dropping,” she emphasised.

“The barrier is the out-of-pocket expenses. Suppose there is  a district health centre which having a dialysis unit, the patient needs to travel 20 km and does not have enough money, and the person who needs to accompany the patient will have to forgo their daily wage, which is difficult, so they are missing dialysis, we are losing patients because of volume overload,” she said

Dr Roy Chowdhury further pointed out that the system has not been able to overcome is the creation of enough pre-dialysis fistulas, a commonly performed procedure for patients who suffer from end-stage renal disease and, those who require permanent vascular access for haemodialysis before carrying dialysis.

“The knowledge (of preparing fistula creation) should spread to the grassroots level, as sometimes we have a dearth of nephrologists to check patients at CKD 2,3 level so that we cannot educate them properly, so this knowledge should reach the primary physicians also,” Dr Roy Chowdhury said.

“All these innovations are bound to fail if we do not prepare the ground immediately,” she emphasised.

Elaborating that prevention should also play a very strong role in LMIC countries like India, Prof Roy Chowdhury said, “One cannot afford the treatment of so many people with dialysis and transplants.”

“Innovative technologies should be taken for supporting the spreading of the prevention message and can empower your community health worker, who had been underpaid for a long period and is currently overburdened, with smartphone-aided guidance so that they can become a good advisor for the large population whom they have access to,” she stressed as a solution.

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