To address the increasing number of Kidney Failure patients in India, the Insurance Regulatory Development Authority of India (IRDAI) has released the much-awaited policy guidelines to include Peritoneal Dialysis (PD) in the ambit of private insurance coverage. According to the guidelines, patients taking treatment of PD can make reimbursement claims on a monthly basis through an approved pre-authorization procedure.

The provisions of the new guidelines have been in effect from 1st October 2020. According to Pradhan Mantri National Dialysis Programme (PMNDP), in India, 2.2 lakh people get affected by ESKD who are on dialysis or transplant for treatment. Dialysis becomes the only option for these patients who are waiting for the transplant. There is a demand of 3.4 crore dialysis with only 4950 dialysis centres approximately in India.

The recent development allows kidney patients to avail the benefits of the home-based and cost-effective PD therapy which can enable both patients and nephrologists to put patients on PD rather than only hemodialysis to aid the kidney failure population in the country.This will also enable both doctors and patients analyze and choose their choice of dialysis treatment based on the patient’s lifestyle. The insurance companies’ long-awaited approval of PD’s inclusion in health insurance plans also comes at an opportune time when the public is cautioned to stay indoors owing to the COVID-19 pandemic and avoid hospital-acquired infections in a healthcare setting.

“IRDAI’s decision of including Peritoneal Dialysis under insurance policies will eliminate the exorbitant expenditure associated with carrying dialysis at home as until now, only the conventional Haemodialysis was covered under insurance policy. Around 63 million people on dialysis are pushed in debt due to expenditure related to health. At times patients miss their dialysis as they fear incurring out-of-pocket expenses. It is critical to understand that every dialysis session matters when a person is suffering from kidney failure. Patients should not be given a single reason to withdraw from the treatment at any point”Now doctors can prescribe the best therapy method to ensure patients receive best treatment without compromising on quality of life.

Dr. Sunil Prakash, Director & Head, Nephrology and Renal Transplant Service, BLK Superspeciality Hospital, New Delhi commented “IRDAI’s decision of including Peritoneal Dialysis under insurance policies will eliminate the exorbitant expenditure associated with carrying dialysis at home as until now, only the conventional Haemodialysis was covered under insurance policy. Around 63 million people on dialysis are pushed in debt due to expenditure related to health. At times patients miss their dialysis as they fear incurring out-of-pocket expenses. It is critical to understand that every dialysis session matters when a person is suffering from kidney failure. Patients should not be given a single reason to withdraw from the treatment at any point” Now doctors can prescribe the best therapy method to ensure patients receive best treatment without compromising on quality of life”.

Dr Mahesh Eswarappa, Professor and Head Department of Nephrology, M.S. Ramaiah Medical College, Bangalore, commented “Insurance policies covering Peritoneal Dialysis under their ambit will save millions of lives residing in remote areas of India. Dialysis demand is growing at a rate of 31 percent in the country. Even though most of the patients suffering from end stage renal disease start dialysis, about two-third of them withdraw due to financial barrier. Earlier IRDAI had recognised only Haemodialysis under insurance schemes but now with PD’s inclusion in insurance policies, we will be able to look at both the treatments at par in terms of coverage. The country has seen less adoption of PD through the years due to high costs. As we are covering it under insurance schemes, treatment through PD should increase now”.

Earlier, only Haemodialysis was covered by health insurance policies but now, the latest revisions in the health coverage can be proven to be more comprehensive and efficient for the policyholders. PD allows patients to move freely at home and maintain a flexible lifestyle. One can perform the therapy as per convenience without having to worry about visiting a hospital unlike the conventional Haemodialysis which demands a patient to visit a hospital 3-4 times a week. PD saves patients multiple clinic visits and is generally more cost effective and scalable as it can be carried out at home and has lower infrastructural requirements.

Despite PD’s potential advantages, its penetration in the country is very poor. According to a report, there were just about 8,500 patients on PD in India in 2019. However, with effective reforms in our healthcare system, such progressive decisions can address challenges pertaining to accessibility and quality healthcare in the country to reach even the vulnerable and the marginalized sections of the society.

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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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