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Haemodialysis impoverishes patients

Households spend 40-80% of family’s non-food expenditure to support life-sustaining treatment

The increasing burden of uncontrolled hypertension in the community and the cost of long-term care for treating the complications of chronic kidney diseases and end-stage renal diseases (ESRD) is impoverishing patients as well as the health system.

A decade ago, people were dying early due to ESRD because dialysis facilities were scarce in the public sector and renal transplant facilities were inaccessible to most. The situation has changed drastically.

Facilities up

The facilities for dialysis and other renal replacement therapies as well as organ transplant have significantly gone up in the public sector.

More importantly, today, there are government subsidies and financial schemes available which have been helping ESRD patients extend their life from dialysis to dialysis.

However, latest reports indicate that the provision of subsidised care and improved facilities have done little to ease the catastrophic financial burden on families with ESRD patients.


A State-wide survey conducted last year amongst 835 patients undergoing maintenance dialysis in both private and public sector facilities have revealed that nine out of 10 households in Kerala, with one patient undergoing maintenance dialysis, are today spending 40 to 80% of the family’s non-food expenditure to support the life-sustaining treatment. Even though nearly 60% of these families have either government subsidy or subsidy in some form, maintenance haemodialysis remained the single-most factor that was pushing these families into catastrophic health expenditure and impoverishment.

The results of the survey, which evaluated the financial hardship of families with an ESRD patient, in association with the provision of medical subsidies, appears in the January 2019 issue of Kidney International Reports.

“Chronic kidney diseases can be impoverishing and none of the long-term sustenance strategies like maintenance dialysis or renal transplant is cost effective in our settings.

Every dialysis centre has at least 100 to 120 patients waiting to get in the queue for chronic dialysis.

It is not easy to get a “slot” or to get a patient started on maintenance dialysis at the proper time,” says Noble Gracious, Assistant Professor of Nephrology, Govt. Medical College, Thiruvananthapuram and one of the lead investigators of the study.

Maintaining a dialysis unit is quite expensive and there are earlier studies which have put the health system costs of a dialysis session at ₹3,025-4,148, while the out-of-pocket expenditure incurred by a patient per session in the public sector is estimated at ₹2,838, a chunk of which is the cost of medicines and consumables.

There are indirect costs as well, which includes expenses of travel, engaging a companion, food and the loss of a work day.

Peritoneal dialysis

The government has now initiated a peritoneal dialysis programme on a pilot basis in select centres to assess its viability over haemodialysis and in the hope that the huge overhead costs can be offset.

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