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The number of deaths attributable to End Stage Renal Disease (ESRD) in India rose from 0.59 million in 1990 to 1.18 million in 2016.
As per a 2018 estimate, the number of patients on chronic dialysis in India is about 175,000, giving a prevalence of 129 per million population. Despite such great number of patients on dialysis, the concept of home hemodialysis (HHD) remains an enigma and largely under-utilised.
There are several preconceived notions about this therapy in the minds of patients and nephrologists which hinders its larger usage.
This study, a first of its kind, is a survey on the views of both nephrologists and patients on HHD in India with respect to its safety and feasibility, medicolegal liability, economics and effects on quality of life (QoL) so we gain clarity on the current situation and take necessary actions for providing better healthcare to the Dialysis population.
184 nephrologists from across India and 54 patients currently undergoing HHD were surveyed on a standard questionnaire. Also, survival data of all the HHD patients from 2012-2023 (n=560) were analysed.
33% Nephrologists believed that HHD had a role to play in upto 10% of their CKD V patients. 70 Nephrologists (38%) actively prescribed this therapy, the rest although not prescribing it, still believed this to be a viable option. Nephrologists feared patient safety and medico-legal risk to the major challenges to prescribing this therapy. However all of them felt that these risks could be mitigated by adopting relevant processes.
60% patients chose HHD out of compulsion arising from immobility or transportation logistics, while the remaining made this as a lifestyle choice. Most of the patients who underwent HHD were from the middle class (60%). Most of the patients were funded by out of pocket payments (70%). Insurance covered this for only 17% patients. More than half of patients (55%) reported an improvement in their quality of life on HHD. Average monthly spend by patients was INR 55-60,000.The 3 year patient survival was 40%.
HHD is a viable option for patients with CKD in Developing economies. It enhances quality of life (QoL) for these patients. There are certain fears that Nephrologists harbour about HHD. However the acceptance of this therapy by patients over the past 10 years as well as their outcomes, support this therapy to be a viable option. Risk perception about HHD by Nephrologists can be mitigated by process standardization and increased awareness among Patients, caregivers and Nephrologists.