(Disclaimer: I am no expert on Dialysis, in India or elsewhere. All I'm going to be doing in the next few posts is presenting my opinion as someone on dialysis in India for the last ten and half years.)
Anna Bennett, guest posting for Bill Peckham, links to this excellent article from RenalWEB by Gary Peterson. For those on dialysis or related to dialysis in some way, this is an absolute must-read. An extract:
I believe we are at the beginning of a new stage, or age, of ESRD care. This phase will correct several major mistakes that began a generation ago, yet are only noticed by a few today. A precise name for this emerging stage has not yet been adopted, but something along the lines of “optimal-health dialysis”, “well-CKD5 patient care” (chronic kidney disease stage 5), “high-dose/frequency dialysis” or “dialysis 3.0” seem applicable."
The article goes over how standards in dialysis have changed over the years. While everyone aspired for "adequate" dialysis all these years, we now should move towards a regime of "optimal dialysis". One important measure of the effectiveness of dialysis has been Kt/V or the Urea Reduction Ratio (URR). People generally accepted a Kt/V of 1.2 and a URR of 65% as good enough.
He goes on to say how this should be replaced by a measure of how good the patient feels and the quality of life he or she is having. This makes so much sense. What good is a Kt/V of 1.2 if the patient is feeling weak, drained and fatigued? Especially, when it is medically possible to make him or her feel much, much better.
He strongly advocates use of more human measures like talking to the patients and finding out how they are feeling than simply using 'blood tests' to determine how well dialysis is working. The US medical reimbursement model (a highly complicated system) relies heavily on big corporations who either provide dialysis treatment or the insurance companies which pay for these treatments. This means that their financials often dictate policies.
The Indian context is entirely different. Dialysis regimens are entirely different. The payment model is entirely different. The facilities are entirely different.
Unfortunately, the system in India is such that most patients either pay for their own treatments or are reimbursed by the companies they work for. Arogyasree is a small step towards changing this model but we are still too far away from even beginning to consider the issues brought out by the author of the RenalWEB article.