Aimed at achieving equity in patient access to home-based peritoneal dialysis; reducing the overall cost of care; and bringing in consistency of practice, pricing and a full range of product availability, the Health Ministry has released guidelines for establishing peritoneal dialysis services under the Pradhan Mantri National Dialysis Program (PMNDP).
It has also requested all States to include proposals for establishing peritoneal dialysis under their respective programme implementation plans. According to a health official, the guidelines aim to serve as a comprehensive manual to States that intend to set up peritoneal dialysis.
Extensive consultation
The guidelines were formulated after an extensive consultative process that was coordinated by the National Health Systems Resource Centre and an expert committee.
Chair of the Committee, Professor Vivekanand Jha, also executive director, George Institute for Global Health-India, said that this move will instantly benefit the 2 lakh Indians who develop end-stage kidney failure every year in India.
“They now have another treatment option that allows them to do dialysis at home with potential flexibility in lifestyle. Mass-based peritoneal dialysis programmes also have the potential to substantially bring down the cost of treatment,” he added.
During peritoneal dialysis, a cleansing fluid (dialysate) is circulated through a tube (catheter) inside a part of the abdominal cavity (peritonealcavity). The dialysate absorbs waste products from blood vessels in the abdominal lining (peritoneum) and then is drawn back out of the body and discarded.
Prof. Jha explained that the Health Ministry had announced the National Dialysis Programme in 2016 and the first phase of the programme envisaged setting up of haemodialysis centres in all districts.
“Given that peritoneal dialysis avoids the substantial costs of infrastructure set-up, maintenance and staffing, reduces the demands placed on the healthcare system and offers patient autonomy, the decision has now been made to include peritoneal dialysis in the ambit of the National Dialysis Programme,” Prof. Jha said.
Children excluded
Arvind Bagga, Professor and Head of the Department of Pediatric Nephrology at the All India Institute of Medical Sciences, Delhi, and a member of the expert committee, said that children with kidney failure were particularly disadvantaged due to the exclusion of peritoneal dialysis from this programme.
“This modality is particularly suited to children who need dialysis because of biological and lifestyle reasons. Further, paediatric haemodialysis facilities are scarce in India,” he added.
The guidelines, meanwhile, envisage providing training to community health workers to provide support to persons on peritoneal dialysis at home or in primary healthcare settings.
‘Self-care tools’
“We recommend that simple self-care tools can be developed, which can help people on peritoneal dialysis to pre-empt development of complications by detecting them early and be in constant communication with care providers,” said Narayan Prasad, secretary general, Indian Society of Nephrology and a member of the expert committee.
