Dialysis Practices Across India - A Nationwide Study
Abhijit Madhav Konnur, Nitiraj B. Shete, Manisha Sahay, Mallikarjun Karishetti, Siddhesh Vishwas Dhaygude, Urmila Anandh, Umesh Khanna, Archit Gautambhai Patel, Dhananjay Shamrao Ookalkar, P S Priyamvada, Bhagwandas Hemandas Kalani, Vipul Chakurkar, N Gopalakrishnan, D Sree Bhushan Raju, Jigar Srimali, Neel Patel, Kailash Shewale, Siddharth Mavani, Maulin K Shah, Maulik Shah, Anil K Patel, Manish Dabhi, Santosh Dilipkumar Durugkar, Kalpesh Gohel, V N Unni, Nagesh Nandkumar AghorBackground
The practise of hemodialysis (HD) is highly variable in terms of geographical distribution, medical enterprises, human resources allocation, financial support, and type of population. This study aims to examine the dialysis practices across participating centers in an incident end-stage kidney disease study in India.
Materials and Methods
Thirty dialysis centers across West, Central, and Southern India were enrolled in April 2019 as part of a point prevalence cross-sectional multicentric descriptive study to examine dialysis practice patterns. Only centers providing more than 500 dialyses per month and a minimum of 10 machines were included. Data were collected using electronic forms.
Results
The distribution of dialysis centers as per ownership was divided into government, private, and public–private partnership (PPP) models, with 4 (13.33%), 7 (23.33%), and 19 (63.33%) each, respectively. The majority (36.67%) of the dialysis centers housed 11–20 dialysis stations. Two (6.67%) of the centers were of large volume, catering > 40 dialysis stations. Around 90% of the dialyzers were reused 4–6 times before discarding. Most centers (50%) performed less than 1000 dialysis per month. All centers had water treatment plants with deionizer and used carbon filters and reverse osmosis technology. Around 93% of the centers used UV light for disinfection. 56.6% of the plants used nonstandardized analysis for chemical assessment of the quality of treated water, while 66.67% utilized culture and sensitivity for microbiological assessment of treated water quality. Patient segregation policy was followed in 93% of the centers, and all centers had qualified nephrologist coverage.
Conclusion
Indian hemodialysis centers are mostly stand-alone and cater to a low to medium volume of end-stage renal disease patients. There has been a shift from privately run dialysis units in the past to the PPP model of dialysis delivery. Most dialysis centers have a quality control mechanism in place.