Tuesday, January 9, 2018

Why more people don’t do nocturnal home hemo in India




I often wonder why more people don’t do nocturnal home hemo in India? To many people, it might seem it is about the cost. I don’t think this is true. I know many people on dialysis who are far more wealthy than I am and yet do not pick this modality.

I think it has a lot to do with fear. Most people have either had a bad experience in the dialysis centre or hospital where they get dialysis or have seen someone else have a bad experience. They fear that should something like that happen at home, how will they be taken care of? They feel that the absence of an emergency support system at home, there could be a high risk of death. The emergency management infrastructure in India is also woefully inadequate. An ambulance could take long to get to you. In the US it is different - help comes to you within minutes.

What many people don’t realise is that if you’re doing daily, nocturnal home hemodialysis, the chances of anything going wrong during treatments are very low - far lower than something similar happening in the hospital. The reason is that the dialysis is much gentler. The blood flow rate and ultrafiltration rates are very low and this dramatically reduces the risk. The risk is not zero but it is low.

Another possible reason is that people do not want to take the hassle of taking care into their own hands. Currently, they show up at the dialysis centre and everything else is done by the team at the hospital. I am not sure if people like the control they get when they bring dialysis home. This is also possibly one of the reasons some people, even if educated about Peritoneal Dialysis are loath to adopt that modality despite the tremendous freedom it gives them. 

The benefits of doing long duration, more frequent dialysis at home are enormous. Freedom from most diet and fluid restrictions, flexibility to fit dialysis into your schedule rather than the other way round, better quality of life, better longevity and lower incidence of comorbidities are only some of them. The low adoption of this modality is there even in countries where people pay little or nothing out of pocket for healthcare. This lends credence to my  assertion that this has to do with things other than affordability.

This is sad because a lot of people are missing out on the better life possible due to this amazing modality.

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