Thursday, January 1, 2009

Dialysis in India - costs, the biggest problem

Most people pay for their own medical treatment in India, kidney related or otherwise. Only people working for the government or large corporations have their medical expenses covered. While this is all right for minor problems that are transient, it can be a lifelong nightmare for chronic conditions.

The cost of one session of hemodialysis is about Rs. 1,200 when the dialyzer and tubings are reused. When a new set is used, it can be about Rs 2,000. This is probably the average cost across India. It could be higher in places like Mumbai and lower in the smaller cities. For someone who does three sessions per week which is the bare minimum, the cost comes to about Rs. 15,000 per month. Add to this, the cost of Erythropoetin, lab tests, doctor consultations and other medicines. The total cost of treatment, then, is atleast, about Rs. 25,000 per month. Friends in the US, please do not convert to dollars and say that is quite cheap. Indians earn in Rupees, remember?

The average Indian cannot afford this expense. I personally know many people who had to undergo the agony of knowing that a treatment is available but they did not have the money to pay for it. Or people who had enough money only for one or two treatments per week. They would come in for dialysis in a terrible shape, totally breathless because of the fluid build-up. Inevitably, you would stop seeing them after a few months.

My gut wrenches when I think of these people. That's when I think - why do we need to send a rocket to the moon when we have thousands of people dying because of the lack of money to be able to afford a life-saving treatment. And we are talking about in-center hemodialysis which is only 'adequate', far from 'optimal'. Will we ever reach a stage when we start talking about optimal dialysis for everyone when we are far, far away from even adequate dialysis?

The problems in India are very different from those in countries like the US. The large population means an even greater number of people needing dialysis. The government does provide free dialysis in hospitals run by the state. But these units leave a lot to be desired. The number of sessions available are also much less than what is required. Government programs like Arogyasree are definitely a step in the right direction. The more I think about it, the more I wonder about how on earth this came about. Whoever conceptualized this really needs to be commended.

In the US, as I mentioned in the first of these posts, there is a lot of discussion going on about optimal dialysis and the measure of good dialysis. They say Kt/V is not a good measure. I have been on dialysis for more than 11 years and I have not had my Kt/V measured even once on hemo. A discussion on whether that measure is good enough or not is moot. Truly, things are very different here.

Here the priority is providing minimal dialysis to everyone that requires it - to save lives. The priority is really not optimal dialysis.

45 comments:

Dinesh said...

Hello Mr. Kamal,

I was searching for data on Arogyasree when I stumbled on your blog (you are 8th on google when one types "arogyasree"!). My mother has been sick and I have been visiting all sorts of hospitals in Hyderabad for the past year or so. And over the period one thing I have noticed is that there is a steady increase in the number of people with the arogyasree card. Now you would expect that in Gandhi, Osmania or NIMS, but the positive development is that more and more of the government insured people are seen Apollo, Yashoda, Care etc. Now one may debate whether it is the government's responsibility is to provide quality heath service rather than simply buy health insurance for the BPLs through Star Health Insurance. You seem to have an understanding of the healthcare scenario from the consumer's POV. And I admire the matter-of-fact nature of your posts on Dialysis. From my interaction with the health industry, it is a challenge to not get emotional and idealistic when dealing with these questions.
Your other blogs are good fun too.

http://dinesh-aditya.blogspot.com/

Mittal said...

Hello Kamal

I would like to correspond with you. Please write to me at ajay.mittal@gmail.com

Could you help me in getting information about the unmet demand for dialysis in various states by income category? If new centres have to be opened, the pricing will have to be differentiated by income levels otherwise it will become simply infeasable to start new dialysis units.

Which are the biggest providers of this service in government and private? I will be very grateful if you can help me get the prices charged currently by each.

Any information you can provide me will be very helpful. I stumbled upon yoru blog while researching kidney problems as I have kidney stones. But if this dialysis problem is so severe as it appears from your blog and others comments here, then clealry more units are needed in India.

Look forward to hering from you

Ajay

goggly said...

Hi Kamal

I am in dialysis industry and it pains me to see the plight of Indian patients go through the agony in a hope to permanent cure that is often a mirage. In the process, their financial reserves , family happiness and peace of mind are robbed by a care that is beyound their means. This is further aggravated by some unscrupulous health care providers who extract their pound of the loot without even patient being aware of any.

I feel greater awareness is what we need. Numbers of CRF are increasing with high incident of diabetes and high BP. First, There is a dire need for Dialysis insurance for people to participate. This can come as a rider to their general hospitalization.Second, Mfrs must bring down the cost of dialysis machine and consumables.

I am keen to know if any institute has made an attempt to idegeniously develop low cost dialysis machine.

It was nice to read your views. They portray the brutal reality of India's health scenario.

Regards

milind

Anonymous said...

Hi All,

Its nice to see people taking part in others problem. I am form ASSAM and the condition of medical facility here is more than worse. And more than that no one is interested in improving the condition specially government. I don't think we have any Dialysis center here, these all are far away from us. We are even away from good basic treatment also. Its not like that people are not ready to spent money, they are spending but for self satisfaction only for trying to save their near one. I think security could be a reason to prevent Big Hospitals to come here, so government have to take some action.

Syed

amy said...

Hi All,

Even compared to US, dialysis in India is expensive. Fortunatly insurance covers and final pay by the patient goes down and effordable. I think Indian government should imply some laws to make lay men afforodable especialy being India is such a populous country.

indu said...

Kamal,

I am extremely pained with the recent loss of my uncle who could not afford treatment. I didnt even know he had option of dialysis. He could have lived longer. He passed away only within a year of kidney problems.

Anonymous said...

I am looking for a dalysis machine to buy or hire. can you please suggest on the same. I am currently at chennai, India.

Please do mail me the details at syed3113@gmail.com

Kamal D Shah said...

Indu, I am really sorry to know about your uncle. Which city was he based in? I am surprised that the treatment was not offered to him.

manish said...

Hi all

I wants to tell you that there is two types of Dialysis-1- Hemodialysis-(Blood is being filtered by the Machine ) 12 hrs/week 2- peritoneal Dialysis- A Small flexible tubing inserted toward abdomen into Peritoneal membrane and a 2 litre solution being filld manually and after 4 - 6hours it will be drained out. this proccess is being done 3 or 4 times a day.


manish.y21@gmail.com

soumya said...

Sir,
my father is having serum creatinine of 3mg/dl...which is high above normal
(Sex:male Age: 64years Weight:68kg)
he is a diabetic patient( for past 10 years) and also has high blood pressure
he is taking medication for both( diabetes and blood pressure )
i am very worried about him and we are currently consulting a nefrologist.
can you tell me that at what level of serum creatinine does a person needs dialysis.
because frankly speaking our family income is much less to the cost of dialysis and i am very worried.
we are residing at hooghly a district in westbengal.
Your suggestion will be helpful.
thanking you
Suman

Kamal D Shah said...

Hello Suman,

It is not a standard number for Creatinine beyond which someone needs to start dialysis. A lot of factors need to be taken into consideration. The nephrologist is the best person to advise regarding this.

All the best,
Kamal

satish said...

Hello friends,
3mg of cretnin is not very much dengerous because my father has 11 one time He is under PD but it costs about 25000 per month!

Dharmit said...

Hello sir,

my father (62 Years) is having CRF since 1996. and his present creatinine is almost 12.00 he is feeling very tired and cant walk and all..he is staying in anand (gujarat). i am thinking to start dialysis nearby. could you please suggest me what to do..i have one question. if we start dialysis once, is it compulsory to continue it for life time?..pls suggest me here or mail me at d4dharmit@gmail.com..thank u sir..

Anonymous said...

hai mr. kamal,
i empathise with you regarding the cost and care of dialysis and dialysis patients in india. i belong to chennai which boasts of medical care capital in india. the government of tamilnadu says it extends medical facility free of cost to all irrespective of income level. Also it dumps different types of good quality medical equipment in all hospitals with out consumables and maintenance facilities. administrative hurdles prevent the doctors from buying any consumables. The Rajiv Gandhi General Hospital in Chennai which caters to 20,000 out patients a day has only 5 haemodialysis machines and only 2 peritoneal dialysis machines. litrally patients are allowed to die due to lack of dialysis facilities. Forget about the facilities in other district hospitals.I dont think dialysis is availble in star health insurance. The apathy continues due to lack of foresightedness from govt machinery though sufficient funds are available and lack of will from doctors baring a few who are constrained by administrative issues. only God could save us.

dilip said...

Hi Kamalji,
I am a 65 year old retired executive (ESRD) on HD since Jan 2011.

However I would like to switch to PD. Can u pls suggest the names of PD service providers ( package) in Pune?
Can u give me some idea of one month's treatment cost?

My e mail is dporedi@gmail.com

Dilip

Anonymous said...

Dear Kamal ji.

tried my best to get the cost of the Dialysis in kolkata but failed came across you blog and got my answer...went through you blog and gave some thought the concern about the rocket and moon stuff guess if the IPL or all indians playing or the board itself donated even 5% percent of the funds to help the poor in this treatment in India more than 50% lives would be saved... But guess thats a lot to ask from them?
cheers
Craig

sunil said...

My present serum creatine is around 1.6 from last two years.
I am suffering from hypertension.
I was in sales and have to travel throghout India working under pressure to achieve targets.Will it be advisable for me to join in such jobs with out
further proress of CKD.

Kamal D Shah said...

Sunil, you must consult a nephrologist. A lot depends on your primary kidney disease.

Anonymous said...

Hi Kamal, I am a 1 year old kidney transplant patient. Yes ofcourse there are people who dies because of lack of money of the treatment.

I am back to normal and working as a consultant in an IT Org. I would like to start a dialysis unit in my town and serve the kidney patients better (This is not a business for me but a service). I have cross the bad stage of my life and its not explainaable that how much pain it is. The painful which i felt is that, the truth that we are depend on lot of peoples to move our life.

Hmmm. Instead of spending money on Rocket Science, they could have reasearch the cause of the kidney diesease. Do anybody knows the cause of the kidneny disease (IGA Nephropathy). Still none of the doctor cant answer to my question.

Manu said...

Hi Kamal,

This is with regard to my Dad who is 61 yrs old and a diabetic patient from the last 21 yrs.
Recently 2 days back he went in for a Master health checkup and his readings are as follows:
Serum Creatinine - 2.7
Blood urea - 47
Protein - 4+
Fasting Sugar - 210
Post - 349

I am very worried as to what condition his kidneys are in.Can u please help me with my concern .I have read many articles wherein its clearly stated that serum creatinine above 2 is a stage 4 CKD.

Can u plz tell me what is his current condition and is he in an alarming situation and if his life span is at risk...Please

Kamal D Shah said...

Hi Manu,

Please send me your email address. You will find the address in my profile the link to which is there in the right bar of the page.

Manu said...

Hi Kamal,

Sorry for the delayed reply...I am kind of having trouble locating the address ...where and how do i send my email id...

chandunirosha said...

hello kamal sir,
my father is a kidney patient for the past ten years.his serum creatine is above 5,for allthese years,nephrolgist told that my fathers needs dialysis,but my father is not acepting to go to dialysis.till last month he has good health with medcines,but now his condition is not good,the serum creatine is increses day by day.i have one question. if we start dialysis once, is it compulsory to continue it for life time?..or it is controlled with medicines after one time dialysis.pls suggest me here or mail me at chandu.bdpl@gmail.com

gopal said...

hi kamal,
my mother was on dialysis for last 5 yrs and expired 3 months back....i want to know the technicalities of the dialysis and want to improve the facilities in india....
please guide on the same

Kamal D Shah said...

Gopal, sorry to know about your mother. Please email me with specific questions.

Thanks
Kamal

ayaaN said...

sir, my mother is patient, she has requirement for dialysis twice in week, we are expected to purchase dialysis machine 4008S, may you tell us dealer of new machine & suggest average or exact rate of it, bcoz we dont have idea about it. my email id is nily.jadeja@gmail.com

Venky said...

Hi Kamal,

I am Venkatesh, President of a Rotary Bangalore Rajajinagar 2012-13. Our club's dream project is to donate 6 dialysis machines to a hospital in Rajajinagar area for an affordable dialysis (Rs. 400-600) to poor and needy. The project cost is 36 lakhs. Our job is to raise 50% (18 lakhs) and rest would be funded by Rotary International. We conducted Hariharan Ghazal show in February of this year and raised 2 lakhs, and we have a kind donor who has agreed to donate 6 lakhs. Our club members collectively have agreed to donate 5 lakhs for this project. Thru this post, if we could find donations, it would be helpful for the community. The donation would be 80G protected.

Thanks again

Kamal D Shah said...

Hello Venkatesh,

Very noble effort! Please let me know if I can help in any way.

Thanks!

Vasundhara Raghavan said...

Dear Kamal:

I was very glad to read your blogs and feel I am getting so much information here. My son had a kidney failure and he was on dialysis and had a transplant, with me as a donor.
I too feel deeply for the cause of patients with the disease.

I published a book on my family story with regard to kidney disease titled, "Shades of Life, Sublime Joy is in Living". If anyone wants to read it, in is available in book stores in India.

Best wishes and May God grant you all patience to care for your health given the tough conditions you are facing.

Vasundhara Raghavan (Ramanujan is surname on the book).

vamsi krishna said...

hai sir iam vamsi krishna diaiysis technician workedin kims when u r having dialysis and iam very happy for your advices to patients.sir can i know your phone number .my number is 09618483335

Anonymous said...

Hi Kamal,

I am Sudhir Gupta, running a charitable organisation.We wish to open a dialysis centre at our place so as to give relief to the poor and needy.
My question is whether we would have to employ a nephrolgist or can we run without his services by getting some trained staff in the field.
Can you suggest some good machine to start with alongwith cost and address of supplier and other medical equipment and medicines needed and its source.
If you could send me an email at sguptamb@gmail.com I shall be highly obliged.

Thanks
Sudhir Gupta

Anonymous said...

Hi Kamal,
Tried checking out for your email ID in your profile. Somehow I'm not able to find it. Could you please let me know where to find it? Needed some info about home dialysis for my mother who is about 57 years old.

Kamal Shah said...

Hi Anonymous, please send me an email at kamal@kamaldshah.com.

lokesh pasari said...

Dear sir,Mr Kamal
myself is attached to a NGO in Kolkata,we provide quality dialysis to needy patients @Rs500/- per session.
If anybody need support call me on my cell no. 09830121001
Lokesh pasari

Jaya Nair said...

Hello Mr. Kamal,

My sister is on Heamo Dialysis since April 2013. Is their any place were we can get a dialysis centre which is affordable. The treatment is so expensive which I am not able to afford. Kindly let us know any place.

Kamal Shah said...

Hello Ms. Nair,

Please send an email to kamal@kamaldshah.com with your location.

Anonymous said...

Kamal sir, My mom is suffering from CKD + diabetes and this was diagnosed in december 2013 after she was admitted in hospital due to general weakness and severe nausea. Later within two months she got admitted twice due to fluid overload causing hypoxia.
The hospitalisations have put me in a very bad position economically already.

Now Dr says she might soon need dialysis started and i am really worried about the cost of the treatment as i am the only one earning and wont be able to bare the expenses. I reside in Chinchwad Pune. Please let me know if there are any NGO's offering dialysis at cost which i could afford.

ghansham.das@yardi.com / ghansham.das@gmail.com

Anonymous said...

Dear kamal sir.

My dad is 50 yrs old diabetic with high bp. Recently we got a report that says creatine is 7.8
Doctors advised for dialysis
We stay in bangalore
Please guide us with some dialysis centre in bangalore at a reasonable price

Thank you sir..

My mail id is Arun.ar1615@gmail.com

Sachdeva, B said...

Dialysis is a lifesaver for someone approaching or at a point when the kidneys have failed. The effect of kidneys in maintaining normal balance is HUGE. Daily filter of blood is what keeps it clean of toxins. A slow decline of function or an acute worsening of kidneys is seen in may conditions, with all manifesting as a rise in Creatinine (ameasure of kidney function, higher the worse, not a toxin itself).

Options for someone at the point pf high toxins and symptoms of toxin accumulation (Uremia) are many fold and involve all major organs of the body. Mind (Weak thoughts, suttle decline in memory early on to a progressive state of confusion-usually a very late manifestation), Breathing (Fluid accumulation, hard breathing, to swelling of the lung tissue), Stomach and food digestion (Nausea, Vomiting, abdominal pain, diarrhea, weight loss), Skin (darkening, dryness, itching, rash) are some of the major manifestations.

Renal Replacement Therapy involves

1. Cleansing blood of toxins
2. Replacing Hormones normally produced by kidney
3. Maintaing normal fluid balance
4. Watching diet


Longest I have seen people do well on dialysis is over 30 years, but transplant remains the single best treatment that replaces all of the functions of kidney.

Sachdeva

Kamal Shah said...

Hello Mr. Arun, I have written an email to you.

Anonymous said...

Sir


I have got your blog during surfing for CKD and found very impressive and u r advising people for CKD. I too need ur valuable advise and information for my father who recently diagonsis with CKD and living in Delhi. His history of CKD is given as below:


My father was taking treatment of high blood pressure and diabetes for since last 10 years. He was very much aware about his kidney problems during last two years when his creatinine level was just 3. He is retired railway employee so getting treatment from railway hospital in conught place. It is free. But now his blood test show that his creatine level go up by 6.2 and blood urea 166. Neproghist at railway hospital only advised that repeat these tests in next month and given special diet management chart. We started diet plan immediately.


Now from last weak he is feeling weak and not able to get up from bed and cannot walk properly. His memory is also effected but no swelling in arms or feets etc. Most of time we found him sleeping with snoring,



I wish to know that is it time to put on dialysis or is it dangerous due to age factor. Can diet will reduce cretanine level? Hope u will give me advice at earlist.


Thanks


-Manu

Kamal Shah said...

Dear Mr. Manu, please send me an email or give me our email id and we can discuss this offline. Thanks!

Anonymous said...

Hello mr. kamal kindly give ur email id at this blog so i can correspond with u
Thanks n regards

-Manu

Kamal Shah said...

The email id is kamal@kamaldshah.com. It is available in the right panel. Anyways, looking forward to your email.

Maniapal-International said...

Dialysis may be used for patients who have acute kidney failure or for those who have permanently lost kidney function. The kidneys normally filter 1500 liters of blood every day and remove all the waste products.In manipal international patient care has very high Infrastructure and doctors with equipments for kidney dialysis cost in India