The healthcare ecosystem continues to battle the COVID-19 outbreak, as different parts of the country draw out unlock strategies. However, it has not been a smooth ride for non-COVID patient’s especially Chronic Kidney Disease (CKD) patients. According to a study, there are around 0.2 million kidney disease patients in India who require a total of 34 million dialysis sessions every year[i]. Owing to mobility restrictions, it is important for kidney patients to really consider a lifestyle changing treatment and adoption of an alternative, more convenient way of carrying out therapies, such as home-based dialysis or Peritoneal Dialysis (PD).

Home-based dialysis or Peritoneal Dialysis (PD).

PD is a form of standard dialysis therapy, which uses the peritoneum in a patients’ abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is a very convenient, home-based procedure which can be done by the patient following basic training and hygiene guidelines. Peritoneal Dialysis is of two types, Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). CAPD involves manual fluid exchanges 3-4 times a day, whereas, APD a more preferred option is performed at night with the assistance of mechanical devices.

PD should become a preferred choice of treatment therapy for many patients for its various advantages. Infact, now, with the deployment of IT-enabled patient monitoring systems or Remote Patient Management (RPM), home care treatment such as PD is being embraced more than ever to aid both doctors and patients. This would not just help manage the disease better but also improve the overall quality of a patient’s life.

APD with RPM is today made possible through cloud-based software such as Share source which provides seamless two-way communication between patient’s home and the hospital care team and helps to promptly identify patients with higher risk of complications. The cost/benefit analysis is strongly in favour of the APD with RPM modality versus APD without RPM.

The COVID-19 pandemic has posed many challenges

 The COVID-19 pandemic has posed many challenges to patients with end stage kidney disease who are on maintenance Haemodialysis. Patients who have opted PD as the form of long-term dialysis are safer and are managing their disease better compared to those on Haemodialysis. PD helps patients to perform dialysis at home without risk of exposure to other infectious diseases including COVID-19 infection.

With the advancements in technology and data connectivity, these patients dialysis parameters can be remotely monitored and required treatment changes can be made without physically meeting the patient. This is done through the Remote Patient Monitoring (RPM). The Clinicians Doctors can optimize the dialysis treatment and patient management with the use of RPM and in addition reduce the administrative burden. Moreover, the use of automated peritoneal dialysis (APD) theoretically reduces the rate of peritonitis and improves quality of life”says

RPM has the potential to improve patient outcomes undergoing PD by facilitating virtual clinical presence, enabling patient-generated clinical documentation and promoting self-monitoring. It enables the clinicians to closely monitor and interact with patients, provide feedback in real-time, and initiate early interventions such as prescription modifications and contextual clinical decision support. Thereby, allowing early detection and interventions to avoid hospital visits.

RPM provides an opportunity to increase the uptake and technique survival of the home dialysis modalities by improving patient satisfaction and outcomes, leading to cost savings. People with CKD can now successfully use RPM without jeopardizing their safety due to Covid-19. The technology used in RPM is reliable and could really make a difference by connecting doctors and patients remotely.

Peritoneal dialysis (PD) have improved quality of life

Peritoneal dialysis (PD) have improved quality of life of a patient as it is cost effective and hassle-free. Now, because of RPM system,  treatment is even better taken care of, remotely observed and altered regularly. RPM also offers further advantages with the current geographic and medical limitations, as it spares the necessity of visiting hospital for treatment analysis. Since timely clinical evaluation is needed in most of the cases, RPM has optimized treatment management connecting the home patient to the clinic.

A key to the success of home-based dialysis, particularly PD, is patient education and training. Thus, enabling PD through platforms like RPM in such challenging times would be highly feasible for patients to improve knowledge regarding self-care, feel the presence of the healthcare professionals remotely while on dialysis at home for better compliance with the dialysis regime and to feel connected with healthcare professionals. Thus,making the treatment remotely accessible and easy.

Dr S Padmanabhan
Nephrologist & Transplant Physician
NU Hospitals, Bengaluru.

[i]https://www.nhp.gov.in/pradhan-mantri-national-dialysis-programme_pg

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Each of us has two kidneys. The kidneys are bean Shaped and about the size of a fist. They are located on either sides of the spine just below the ribcage. The main function of the kidneys is to filter the extra water and waste products from the blood and make urine. They also help in keeping blood pressure under control and keeping bones healthy. They make certain hormones that our body needs to stay healthy.

Kidney diseases:

There are two major types of kidney disease, namely acute and chronic kidney disease. The acute variety is due to various causes like drugs, infections, dehydration, radio contrast injections etc. The acute kidney injury or failure is curable. Some may need dialysis support for a short period before recovery. Chronic kidney Disease (CKD) is one in which the kidneys are damaged slowly and irreversibly. As a result the kidneys are not able to do their job. Waste and water builds up in the blood. This is very harmful to the body and makes the person unwell.

It is estimated that 20 million people are suffering from CKD worldwide. Above one million patients are being treated for End State Kidney Disease (ESRD) with dialysis or transplantation. The incidence of CKD is increasing raidly. In India only about 5% of the patients get some form of treatment for ESRD for the rest it is either not available or prohibitively costly.

Chronic Kidney Disease (CKD) is a silent disease!

There are no symptoms in the early stages of the disease. Symptoms occur only in the late stages of the disease. Early detection of CKD is possible only by testing the blood and urine. The following are some of the symptoms of kidney disease:

1. Getting tired easily.

2. Poor appetite.

3. Sleep disturbances.

4. Swelling of feet and ankles.

5. Early Morning puffiness around the eyes.

6. Frequent urination, especially at night.

There is no cure for chronic kidney disease. It slowly gets worse over time. Kidney disease can turn into kidney failure (End Stage Kidney Disease). At this stage the only treatment options available are DIALYSIS AND KIDNEY TRANSPLANTATION.

Diabetes is the most common cause of CKD:

Diabetes is a very common ailment now. An estimated 177 million people have diabetes worldwide. It is predicted that by the year 2030, 360 million people would be suffering from diabetes worldwide. About 40% of the diabetics are likely to develop kidney disease. This makes diabetes the most common cause of CKD.  High blood pressure, hereditary diseases like polycystic kidney diseases, kidney stones and urinary infections are some of the other cases of chronic kidney diseases.

Early detection of kidney disease helps:

If detected early, right treatment can prevent further damage and slow down the progression of kidney disease. Prompt treatment with medications like ANGIOTENSIN CONVERTING ENZYME inhibitors or ANGIOTENSIN RECEPTOR BLOCKERS and other measures including diet and lifestyle modifications can keep the kidneys healthy for a longer period of time. If you have one of the risk factors it is worthwhile to get screened for kidney disease with blood and urine tests. The risk factors for chronic kidney disease are:

1. Diabetes

2. High blood pressure

3. A close family member suffering from kidney failure

4. Age over 50 years

5. Having heart disease

Tips to keep kidneys healthy:

1. Get blood and urine checked for kidney disease if at risk.

2. Diabetic patients   need   to   get   their kidney tests done at least once a year.

3. Keep blood pressure below 130/80.

4. Keep diabetes under control.

5. Keep cholesterol  levels  in  the  target range.

6. Take medicines as prescribed.

7. Eat healthy and cut back on salt.

8. Quit Smoking.

9. Be physically active.

10. Maintain healthy body weight.

The kidney tests:

1. Serum creatinine   level   and   eGFR estimation.

2. Urine for albumin.

Know your kidney Number – GLOMERULAR FILTRATION RATE(GFR):

GFR stands for Glomerular Filtration Rate. GFR measures how much blood your kidneys filter each minute. It is reported as a number. It is calculated from the blood creatinine levels.

1. GFR of 60 of higher is in normal range.

2. GFR below 60 may mean you have kidney disease

3. GFR of 15 or lower may mean kidney failure.

Urine albumin test:

Urine test detects protein or albumin. Albumin does not pass through a healthy kidney into the urine. If kidneys are damaged, albumin can pass into the urine, One cannot see or feel albumin in urine. So urine test is very important to detect kidney disease.

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