KOTTAYAM: Despite the alarming rise in the incidence of end-stage renal disease (ESRD), nephrologists are sounding concerned over the under-utilisation of home-based continuous ambulatory peritoneal dialysis (CAPD), a cheaper and less-invasive option for patients compared with widely used haemodialysis (HD).
Even though CAPD was introduced in Kerala two decades ago, this alternative to hospital or home HD is often overlooked, as many doctors themselves harbour prejudices against it.
A national conference and workshop on home peritoneal dialysis (HPD), organised recently by Believers Church Medical College Hospital (MCH) in Tiruvalla, in collaboration with the Central Travancore Nephrology Club, observed that CAPD is used only in marginal cases.
The summit, attended by over 200 nephrologists from across the country, along with other healthcare professionals, focused on promoting HPD as a primary option for patients with chronic renal disease.
The event also underscored the benefits of home-based treatments for patients with chronic kidney disease.
“HPD enables patients to manage their treatment in the comfort of their homes, eliminating the need for frequent hospital visits and needle-based procedures associated with conventional haemodialysis. This method also reduces travel expenses and impact on incomes, while significantly improving the quality of life. Despite these advantages, HPD remains under-utilised in Kerala due to limited awareness and training,” said Dr E T Arun Thomas, senior consultant at Believers Church MCH.
Although the state government rolled out a PD scheme to provide free treatment for kidney patients at home last year, it still lacks acceptance among both patients and doctors.
The scheme offers dialysis fluids, catheters and other accessories at no cost to registered patients. Additionally, the central government provides free dialysis fluid for CAPD through the Pradhan Mantri National Dialysis Programme (PMNDP). However, as per available data, out of the nearly 25,000 renal patients in the state, only around 500 choose CAPD.
Dr Noble Gracious, associate professor at department of nephrology at Government T D MCH, Alappuzha and executive director of Kerala State Organ and Tissue Transplant Organization, points out multiple reasons for lack of acceptance for CAPD.
“CAPD requires more responsibility from patients, doctors and the government. Patients or their caregivers bear the responsibility of performing PD at home, which often leads to anxiety. Alternatively, patients can opt to receive HD at a dialysis centre.
On the healthcare providers’ end, doctors must be readily available to address patients’ concerns and provide guidance through frequent phone calls. Additionally, in emergency situations, patients may need to be transitioned to HD, further complicating the treatment process. These challenges often create significant stress for healthcare professionals,” he said.
HD requires treatment three times a week, while CAPD necessitates treatment three times a day, involving approximately 21 bags of fluid per week.
However, nephrologists pointed out that running HD units require significant investments in terms of infrastructure, human resource and maintenance costs.
“According to available reports, while the state govt spends around Rs 1,600 crore under the Karunya Arogya Suraksha Padhathi (KASP), nearly 40% is given for HD. Additionally, despite expanding the dialysis network in the public sector, hundreds of ESRD patients continue to be on months-long waiting lists,” said Dr P Shamnad, a nephrologist.
The Believers Church MCH conference advocated adopting a ‘home-PD-first’ approach. Experts called for integrating home PD into healthcare systems and stressed the importance of training to address the skill gap. Dr Biju K Gopinath, secretary of the Nephrology Association of Kerala, proposed implementing a ‘make-in-India’ project for manufacturing consumables for home PD.
PD utilises the peritoneum, a membrane lining the abdominal cavity, to filter waste and excess water from the body. A catheter delivers a special dialysate fluid into the abdomen, where it absorbs waste and extra fluid before draining into an empty bag.