Patients with end-stage renal disease (ESRD), who have to go on maintenance dialysis to extend their survival, have the option of hospital-based haemodialysis (HD) or home-based continuous ambulatory peritoneal dialysis (CAPD)
Running HD-units involve heavy investment for the health system in terms of infrastructure, HR, and maintenance costs. Despite expanding the HD network in the public sector, hundreds of ESRD patients continue to be on the waiting list.
Thailand, Hong Kong, Australia, Spain, and China have all reported that CAPD is cost-effective in the long-term and have a “CAPD first” policy when it comes to initiating treatment for all new ESRD patients.
However, CAPD is not even offered as an option to ESRD patients in India and doctors themselves are prejudiced against it. CAPD involves the surgical implantation of a soft catheter into the peritoneal cavity at the abdomen. After wound healing, patient and his/her carer can be trained to perform the simple procedure of performing dialysis using special fluids, at home. Training has to be given in aseptic measures to prevent the risk of infections. The procedure takes about 40 minutes and has to be repeated thrice a day.
Last year, the Health Department decided to start CAPD units on a pilot basis at the GH in Thiruvananthapuram and Ernakulam and the Palakkad District Hospital.
The CAPD kits and fluids, which are expensive, will be provided to patients through Karunya medical stores at subsidised rate. It was the success story of the Palakkad DH, which took the lead in initiating and maintaining its ESRD patients on CAPD since 2017 that prompted this.
“We have 120 patients on CAPD and 80 on HD today and our analysis shows that in the initial years of dialysis, the outcome or survival rate for patients is better with CAPD than HD. Our analysis shows that if the monthly cost for thrice-a-week HD per patient is ₹27,000, the per patient cost for a month of CAPD is ₹23,000. This means that we are saving ₹4,000 per patient every month, apart from the savings for the patient in terms of indirect costs. If the government were to step in and subsidise costs, then CAPD is the best option for patients on the waiting list for HD,” says T. Krishnadas, consultant nephrologist at the Palakkad DH.
“It does take a lot of commitment, patience, and care on the side of both patients and the doctors to maintain a patient on CAPD and ensure that he follows all aseptic measures. We have to constantly counsel and motivate the patient because he is in charge of his treatment. But once he understands the advantages – fewer hospital visits, savings on travel costs and medicines, less disruption to normal lifestyle – he is willing to stick on to CAPD,” Dr. Krishnadas says.