In a new development in the care of patients with kidney disease, the Ministry of Health and Family Welfare has come out with a set of guidelines for establishing peritoneal dialysis services under the Pradhan Mantri National Dialysis Program.
The guidelines aim to serve as a comprehensive manual to states that intend to set up peritoneal dialysis services and for providers of peritoneal dialysis as a ‘best practice’ document to ensure delivery of high quality and cost effective services.
It also aims to achieve equity in patient access to home-based peritoneal dialysis, reduce the overall cost of care to the system by focusing on efficient leveraging of resources, and bring in consistency of practice, pricing, and a full range of product availability.
The guidelines are a result of a consultative process coordinated by the National Health Systems Resource Centre and an experts’ committee chaired by Dr Vivekanand Jha, Executive Director of the George Institute for Global Health, India, and consisting of nephrologists from around the country, as well as health systems and policy experts.
“This is good news for about two lakh Indians who develop end-stage kidney failure every year in India. They now have another treatment option that allows them to perform dialysis at home with potential flexibility in lifestyle. Mass-based peritoneal dialysis programs also have the potential to substantially bring down the cost of treatment,” said Dr Jha, who is also the president of the International Society of Nephrology.
The government had announced the National Dialysis Program in 2016. Its first phase envisaged setting up of haemodialysis centres in all districts. Now, it has been expanded to include peritoneal dialysis considering that it offers patient autonomy and would help reduce the demand on healthcare system and avoid substantial costs on infrastructure, maintenance and staffing.
The new guidelines, among other things, envisage providing training to community health workers to provide support to persons on peritoneal dialysis at home or in primary healthcare settings.
“Our evaluation of the implementation of the haemodialysis program in Andhra Pradesh shows that it is critical to make quality dialysis services affordable for people living in rural areas. Establishing peritoneal dialysis services under proper supervision of trained manpower can go a long way in making this a reality,” pointed out Dr Jha.
Prof Arvind Bagga, Professor and Head of the department of Paediatric Nephrology at the All India Institute of Medical Sciences and a member of the Expert Committee, said, “Children with kidney failure were particularly disadvantaged due to the exclusion of peritoneal dialysis from this program. This modality is particularly suited to children who need dialysis because of biological and lifestyle reasons. Further, paediatric haemodialysis facilities are scarce in India.”