Written by Umesh Khanna
The pandemic has upended healthcare systems worldwide. Numerous dialysis centres were shut during the lockdown as they were designated as COVID-19 centres. Restricted public transport and the risk of contracting the infection at a dialysis centre have raised apprehensions among patients of kidney-related diseases. There have been reports of patient to patient COVID-19 infection transmission in dialysis centres as well. For the nearly 3 lakh Indians who require 34 million dialysis sessions in total, every year, innovative remote patient monitoring (RPM) technologies such as the sharesource platform are shaping the new standard of chronic patient.
There are two types of dialysis – haemodialysis (HD) and peritoneal Dialysis (PD). Conventionally, HD is used for dialysis in hospitals. In the case of PD, the inside lining of the abdomen acts as a natural filter and unlike HD, this procedure can be conducted at home. As per current estimates, there are about 6,500 patients on PD in India.
There are two types of PD — continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD cannot be performed without human intervention whereas APD is performed with mechanical assistance. With the use of advanced medical technology, APD allows efficient use of healthcare resources — remote patient management techniques reduce the frequency of in-person visits for emergency problems. However, currently about 500-550 patients are being treated through the APD procedure in India and about 125 patients are undergoing APD treatment through cloud-based technology such as sharesource.
PD is enhanced with remote systems that collect medical health data from individuals after completion of the therapy and electronically transmit them to a doctor at a different location for assessment and recommendations. The doctor can then access this information about the patient’s treatment history which enables them to make clinical decisions in a timely manner. Doctors can also track events that may arise during home dialysis and adjust the patient’s device programme from anywhere around the world.
Due to the nature of the disease, people with ESRD (end stage renal disease) on dialysis require different settings for therapy sessions. PD with remote patient monitoring (RPM) system promises real time data transmission for such patients. Many countries including Taiwan, China, New Zealand, Vietnam, Australia, and the US have witnessed an exceptional expansion in the use of PD.
Let us understand how PD with the remote monitoring system works. To begin with, for pre-PD set up, the patient needs to see the doctor who places a soft plastic tube called catheter into the abdomen by surgery. One end of the catheter remains outside the abdomen via a small incision in the skin. Dialysate or the solution with dextrose and other additives (PD solution/medicated fluid) flows into the abdomen through the tube. While the dialysate stays inside the abdomen, it soaks up extra fluids and waste from the body. The most feasible part of this kind of dialysis is that during the entire procedure the patient can move around and carry normal activities. Meanwhile, the RPM system simultaneously transmits data to a safe platform through which the doctor can access the information.
Schemes like Ayushman Bharat Yojna have accelerated the use of digital tools and promoted healthcare technology. Such technologies offer a customisable dashboard to the doctors that can be organised based on the individual patient’s needs. Under the Pradhan Mantri National Dialysis Programme, the government has included PD in the National Health Mission policy in 2019. The PD service would be provided free of cost to people below the poverty line and for non-BPL patients, the service would cost as much as the government pays for BPL patients. The government has also asked states to include proposals for establishing PD in their healthcare plans. However, very few states have taken action on this matter.
To provide affordable and safe healthcare to all in trying times such as the pandemic, there is an urgent need to introduce and spread awareness of therapies like PD that rely on remote patient monitoring technologies.
The writer is a Nephrologist and Chairman, Mumbai Kidney Foundation
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