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India accounts for a huge percentage of the global burden of diseases and this seems to be largely driven by lack of quality healthcare infrastructure and unequal access to health services. The pre-existing cracks in India's healthcare system became clearly visible during the second wave of the COVID-19 pandemic, with thousands of people dying due to shortage of hospital beds, oxygen and essential medicines. Sadly, access to healthcare is a big challenge for a large portion of the country's population, including those with chronic kidney disease who need dialysis.
"India is currently faced with a silent health crisis as the prevalence of chronic kidney disease (CKD) continues to surge. The more worrisome situation is the fact that access to healthcare is still elusive for a large portion of the population, including those needing dialysis," says Prabhat K. Shrivastava, Co-Founder and Director VitusCare Dialysis Centres.
In an exclusive interaction with the HealthSite, the expert sheds light on rising cases of chronic kidney disease in India, lack of quality dialysis, and what steps can be taken to overcome this problem.
According to a 2020 study, the prevalence of CKD in India was 15 per cent, but various studies have also pegged the rate at 17 per cent in recent times. This is far above the global rate of around 9 per cent (850 million people) and paints a very dire picture in the South Asian nation. At least 2.2 lakh new patients of end-stage renal disease are added in India each year. That puts a strain on the already burdened dialysis sector which currently accommodates 1.75 lakh patients. Also, less than 6,500 kidney transplants are done in the country each year.
Ideally, India requires 3.4 crore dialysis annually, but available data shows there are only about 2600 nephrologists and 15,000 dialysis centres in the country. This inadequacy throws up the challenge of access for the poor with clear indications of the natural laws of demand and supply.
There has been a widespread call for interventions in the sector to ensure that quality dialysis is accessible to all who need it. Unfortunately, that is not the case at the moment, and there is a need to investigate the factors that are causing this.
The foremost reason why many renal patients in India can't get dialysis is that they can't afford it. Dialysis may prove to be an expensive therapy to embark on, due to its recurring/chronic in nature. On an average, each patient requires between 10 to12 sessions monthly at an average of cost of ~1,600 per session. That is about Rs 16,000 to Rs 18,400 monthly, and roughly Rs 2,40,000 annually. In addition to this, there are lab tests, doctor consultation and medicines that patients have to take regularly to ensure the efficacy of the therapy.
Secondly, the issue of accessibility is huge. Today most of the dialysis centres are mostly located in the urban and semi-urban regions and they are far in-between. This often means a renal patient would need to travel long distances for getting dialysis sessions/ lifesaving therapies. Individuals, living in hard-to-reach hinterlands are the most affected owing to this fact and need to spend significant amount of time and money in travelling to their nearest dialysis centre.
Awareness/lack of information is another major issue here. Early detection and treatment are major determinants for successful dialysis, but with many Indians only spotting CKD at an advanced stage/4th or 5th stage and the large-spread reluctance to visit the doctor immediately, CKD management becomes biggest challenge. The manifestation of disease takes place quite late and the lack of doctors/nephrologist in tier 2 and 3 implies a further delay in getting the required disease management.
The issue of affordability is getting resolved to a great extent now with help of government intervention. The Pradhan Mantri National Dialysis Programme under the National Health Mission is one of such crucial interventions which has led to setting up of dialysis projects in many parts of the country. The central and state governments have also come together to initiate other schemes such as the Ayushmaan Bharat scheme, which has allowed great access to medical infrastructure, including dialysis, in the tier 2 and 3 towns of India.
Also worthy of mention is the role of the private sector which is a major driver of the dialysis sector in India. The penetration of organized dialysis providers has enabled dialysis centers to provide improved renal care eco-system through new and innovative business models initiated by startups in this space, and it is hoped that this momentum will be sustained into the future, allowing for improved accessibility to quality dialysis centres and better clinical outcomes for the renal patients. These startups through use of technology bringing efficiency and delivery innovation are not only able to run the centres in the hinterland of the country but are also able to ensure access to nephrologists which has thus far been a biggest challenge owing to their limited number.
With the challenges of affordability being addressed by the government, there is now an increasing need to build a robust and sustainable framework by the government which will enable the private organized players in addressing the accessibility of dialysis centers for renal patients and also start enabling the primary health centers across the country with the required skill-set and facilities for CKD screening to promote early detection as this would go a long way towards increasing the longevity of patients' lives.
The kidneys help remove waste products and excess fluids from the blood via urine. This function can be impaired due to a disease or condition, leading to chronic kidney disease, which is also known as chronic kidney failure. High blood pressure, diabetes, smoking, obesity, older age, and frequent use of certain medications are some of the risk factors of chronic kidney disease. In most cases, chronic kidney disease is diagnosed when the condition has reached an advanced stage. End-stage kidney failure is a fatal stage.
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