Do-it-yourself dialysis

Home dialysis is picking up because of the convenience with which it is used

A 25-year-old photo journalist from the North-east, a 28-year-old computer engineer from Hyderabad, a 36-year-old lady from Phittoragh and a 30-something Delhi-based housewife are all sharing a common platform.

They are all on home dialysis. And joining them are around 4,300 patients who are supplied kits from companies such as Baxter (India), Fresenius, J Mitra and Claris Lifesciences.

All these patients are suffering from End Stage Renal Disease (ESRD). But they are relatively lucky, for out of 1 lakh-odd people suffering from ESRD, only 20 per cent have access to treatment that includes a kidney transplant, haemodialyis and peritoneal dialysis.

We generally assume that a person who suffers from renal failure goes to the hospital two or three times a week to get dialysis done. Haemodialysis (HD) is done outside the body. A fresh flow of pure blood is administered through a machine and the patient is assisted by hospital staff.

Home dialysis or peritoneal dialysis (PD), as it is called in medical terms, uses the lining of the abdomen within the body for dialysis and is done at home by patients themselves.

"A catheter is inserted into the patient's abdominal cavity and the waste products from the blood diffuse out from the peritoneal membrane into the dialysis solution and finally leaves the body," says Harish Natarajan, business unit director-renal, Baxter.

And the more common of the PD is the continuous ambulatory peritoneal dialysis (CAPD), which, as the name suggests, allows the patient mobility. "The patient can work absolutely normally and also play sports, dance etc" says Natarajan.

Some nephrologists (doctors specialising in renal diseases) feel that dialysis should be done as frequently as possible and (PD) meets that requirement.

"We normally recommend 3-4 exchanges or dialysis a day while HD is not done more than twice a week," says Dr Amit Gupta, professor, Nephrology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow and president, Peritoneal Dialysis Society of India.

And what are the advantages of home dialysis besides not having to go through the trauma of being hospitalised again and again? Gupta says one big advantage of doing the dialysis at home is being assured of contracting no infection including deadly ones like Hepatitis B and C, or HIV.

"Also, each time a patient gets haemodialysis done, there is a certain amount of blood loss which is not there in PD. Besides, HD causes fluctuations in blood pressure and can also lead to heart stroke. Diabetes patients specially need to be cautious," says Gupta.

And there is more good news for patients who are foodies. There are few dietary restrictions when one is on PD. With hypertension and diabetes becoming two major killers in India, more and more people are prone to renal failure.

And not everybody is lucky enough to have a successful kidney transplant "" not only is it difficult to find a donor but sometimes a body does not accept a foreign kidney. Some of the patients have already undergone two failed transplants.

But the good news is that patients have been living a healthy life on PD for over a decade. "The ease with which it is administered makes it a part of one's life," says Gupta.

While both HD and PD cost around Rs 13,000-15,000 a month, PD is extremely helpful in cases of patients living in remote areas.

"For Bharati Chand, the patient from Pittoragarh, reaching Haldwani, the nearest dialysis centre, when she was on HD, was a bigger ordeal than the dialysis itself," says Natarajan.

Baxter has even helicopter dropped PD kits to a UK-based patient, Tony Ward, who did PD exchanges on a three-day climb to Mount Blanc Clearly, there is life beyond renal failure.