The government may soon establish peritoneal dialysis services across states to provide door-step dialysis services for kidney patients, said a government official. The Union ministry of health and family welfare has set guidelines under the Pradhan Mantri National Dialysis Programme (PMNDP), asking states to include the services to implement the programme, he added.

Peritoneal dialysis is a process to remove excess fluid, correct electrolyte problems and remove toxins using the lining of the abdomen, or peritoneum, in patients suffering from renal failure. If the proposal is implemented by the states, patients can avail dialysis, along with several other services, at home.

With home-based peritoneal dialysis service, the Centre seeks to bring down the overall cost of treatment by efficiently leveraging the resources, which in turn will help all patients suffering from renal failure to have easy access to the services, the official said, adding that a full range of products will be made available under the programme over time.

According to the government, the guidelines will serve as a comprehensive manual for best practice for states intending to set up peritoneal dialysis centres to ensure delivery of high-quality and cost-effective services, and develop a clinically-safe and effective programme.

“The move will benefit about 200,000 people who develop end-stage kidney failure every year in India. They now have another treatment option that allows them to do dialysis at home with potential flexibility in lifestyle. Mass-based peritoneal dialysis programmes also have the potential to substantially bring down the cost of treatment," said Professor Vivekanand Jha, chairperson of the expert committee tasked with writing the guidelines. Jha is also the executive director of the George Institute for Global Health.

The health ministry had announced the launch of the National Dialysis Programme in the 2016 budget. The first phase envisaged setting up centres for hemodialysis.

Peritoneal dialysis does away with the substantial costs of infrastructure, maintenance and staffing, reduces the demand on the healthcare system and offers patient autonomy. “It has been decided to include peritoneal dialysis in the ambit of the National Dialysis Programme," the government official said.

“Our evaluation of the implementation of the hemodialysis programme implemented by Andhra Pradesh under the PMNDP shows that making quality dialysis services affordable for people living in rural areas of the country is critical," Jha said. “Establishing peritoneal dialysis services under the supervision of trained manpower can go a long way in making this a reality. Our research shows that home-based or self-dialysis can improve the quality of life as well as be cost-effective in the long run."

The guidelines also address problems faced by paediatric patients. “Children with kidney failure were particularly disadvantaged because of the exclusion of peritoneal dialysis from this programme. This modality is particularly suited to children who need dialysis because of biological and lifestyle reasons....," said Arvind Bagga, a member of the expert committee, and professor and head of the department of paediatric nephrology at AIIMS, New Delhi.

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