Peritoneal dialysis can ease CKD burden

The burden of Chronic Kidney Disease (CKD) has reached an alarming stage in India. It is currently one of the most commonly occurring non-communicable diseases. In India, 40-60% of CKD cases can be attributed to diabetes and hypertension. Unfortunately, despite its steadily increasing incidence, kidney disorders are still not a high priority condition in India. 

Chronic Kidney Disease (CKD) is an incurable and progressive disease that decreases the function of the kidney over a period and the patient requires lifelong care and medical treatment. During the initial stages of the disorder (stage 1-3), a patient is usually given medication and is asked to follow a certain diet pattern.

However, when it reaches the advance stages (stage 4 or 5), the patient is required to undergo a renal replacement therapy — transplantation or dialysis to manage the condition. In most of the cases, patients undergo dialysis to manage this condition. There are two types of dialysis — haemodialysis and peritoneal dialysis.

As a nephrologist, a patient’s appropriate treatment and comfort is my top priority. Hence, I recommend Peritoneal Dialysis (PD). It is a needle-free dialysis treatment option that best replicates the natural kidney function.

As part of PD, a special sterile fluid is introduced into the abdomen through a permanent tube that is placed in the peritoneal cavity. The fluid circulates through the abdomen to draw impurities from surrounding blood vessels in the peritoneum, which is then drained from the body. This can be done overnight or during the day around three to four times and each session lasts approximately 25-30 minutes. 

The benefits of peritoneal dialysis are:

• Replicates the natural kidney function 

• Food restrictions are minimal

• Low fluctuations in the blood pressure level

• Offers more flexibility in terms of comfort 

PD offers more flexibility by allowing patients to dialyse from the comfort of their own home or at work, but its penetration in the country is still low. The reasons include lack of awareness, unavailability of insurance reimbursement and prevalent attitude barriers. There is a need to address these barriers at various levels. 

The most prevalent attitude barrier is a patient’s fear to dialyse without direct medical supervision or fear that they will not be able to perform self-care dialysis adequately.

There is a need for regular counselling of patients and their caregivers on the treatment procedure/protocols. Further, deployment of technical support staff for PD patients should be very helpful.

There is a need to build awareness about PD in the medical fraternity so that they consider it a preferred therapy option for a CKD patient.

As in-charge of the Peritoneal Dialysis Society of India, I ensured the inclusion of PD in the medical curricula of Doctorate of medicine (DM) and Diplomate of National Board (DNB) students. Moreover, nurses and PD technicians should also be provided with effective training from the fraternity to be able to cater well to the patients. 

The medical fraternity, policymakers and other important stakeholders must work collectively in helping patients get access to the Peritoneal Dialysis therapy and achieve the best treatment outcomes through simplified care. 

(The writer is Senior Consultant Nephrologist & Director, Nephrology services, Apollo Hospitals, Bengaluru)

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