After my last post, I got several enquiries on what exactly the cost of Home Hemodialysis in India was. I was also requested to create a separate post on this and so here it is.
The Initial Cost includes the cost of setting up the system at home including the machinery, plumbing and electrical connections. The Recurring Cost includes the cost of the consumables, the salary of the technician, water, electricity, maintenance cost of HD machine and RO plant etc.
We must bear in mind that each of these costs would vary greatly depending on location, frequency and duration of the dialysis sessions, type of dialyser, whether the dialyser and bloodline is being reused or not etc.
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Bed: 0 to Rs. 1L (depending on whether you would use your own current bed or maybe a multifunction bed which allows you to move it to the Trendelenburg position (in case of low BP) etc.)
Cost of a dialyser and bloodline is the same as that you probably pay at your current centre (Rs. 500 - Rs. 1000 for the dialyser depending on whether you are using low flux, middle flux or high flux and between Rs. 150 - 175 for the bloodline). The cost per session of this can be brought down if you reuse the dialyser.
Rest of the consumables would cost around Rs. 300-400 assuming a four hour session. For a nocturnal session, it would be slightly higher, maybe around Rs. 500-600.
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Initial cost: Rs. Rs. 7L to Rs. 10L depending on various options (everything new, for second hand, refurbished stuff, maybe about 60-70% of this)
Nowadays, several dialysis providers also provide home hemodialysis services where they will take care of everything. This will include setting up the infrastructure, supplying consumables, arranging a technician and taking care of biomedical waste and machine maintenance. This will be more expensive though.
So, if you do the same frequency and duration as in your current hospital based dialysis centre, the monthly cost can come to around the same as that you are paying now. The initial cost is something that needs to be considered though. This can also be reduced if you go for a refurbished machine. There is a small chance of the machine giving problems though.
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The beauty of home hemodialysis though is when you do it more frequently and for longer durations. For example, doing five nights a week, for 7-8 hours each night can improve clinical outcomes and quality of life dramatically. Several people report an almost normal quality of life with this regimen. Studies have also shown that the outcomes with this modality rival that of a deceased donor kidney transplant.
My own experience with this modality has been excellent. Honestly, I have got my life back and I have documented this in great detail on this blog as well. The return on investment has truly surpassed all expectations for me.The reported benefits of home hemodialysis may not be experienced by all patients. Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are not for everyone. View Risks and Responsibilities
With the help of your doctor and care team, System One also allows you to determine where, when, and how frequently you will perform your treatments so they best meet your clinical and lifestyle needs. In addition, the Nx2me Connected Health app collects your treatment information directly from the cycler and provides flexible viewing, monitoring, and reporting, to your clinic to help reduce the burden of capturing information on paper flowsheets.
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24/7 Technical Support is provided to all home patients and available even while traveling, adding another layer of confidence for patients and providers.
The System is a prescription device and, like all medical devices, involves some risks. The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set.
Home hemodialysis with the System during waking hours may not require a care partner, provided a physician and a qualified patient agree that solo home hemodialysis is appropriate. Patients performing nocturnal treatments are required to have a care partner. Care partners are trained on proper operation and how to get medical or technical help if needed.
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Certain risks associated with hemodialysis treatment are increased when performing solo HHD because no one is present to help the patient respond to health emergencies. If patients experience needles coming out, blood loss, or very low blood pressure during solo HHD, they may lose consciousness or become physically unable to correct the health emergency. Losing consciousness or otherwise becoming impaired during any health emergency while alone could result in significant injury or death. Additional ancillary devices and training are required when performing solo HHD.
Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow and/or increased treatment time, and delayed response to alarms when waking from sleep.
Fresenius Medical Care has successfully completed its merger with Medical Inc. By strengthening our vertically integrated dialysis business, the merger supports our initiative of driving growth in the core business with innovation, better clinical outcomes through Care Coordination and improving the patient experience. For information about products and services please continue to use this website. To learn more about Fresenius Medical Care and the merger, visit the links provided.The ministry has sent guidelines to the states and Union Territories, urging them to train staff and ensure the patients receive the special fluid used in peritoneal dialysis (Shutterstock)
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The Union health ministry has decided to provide peritoneal dialysis, a home-based alternative to haemodialysis that typically requires thrice weekly hospital visits, to patients with end-stage kidney disease across India under the National Dialysis Programme.
It will be available free to below-poverty-line patients and at a cost to the rest, just as haemodialysis is under the NDP.
The ministry has sent guidelines to the states and Union Territories, urging them to train staff and ensure the patients receive the special fluid used in peritoneal dialysis.
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In peritoneal dialysis, the peritoneum — the membrane lining the cavity of the abdomen and covering the abdominal organs — is used to filter wastes and excess water from the blood.
A catheter delivers the special dialysate fluid into the belly, where it absorbs the wastes and extra fluid from the blood and drains out into an empty bag.
This is done two or three times a day, with the catheter permanently in place, and the patient has to periodically empty the bag in which the waste collects.
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Health-care workers need to visit the patients at their home just once to insert the catheter and instruct them on how to carry out the self-dialysis.
Research suggests that home-based self-dialysis carries a lower risk of infection than the twice or thrice-a-week dialysis sessions in clinics or hospitals.
Haemodialysis services under the NDP, launched in 2016, are available through 765 clinics in 444 districts, delivered through over 4, 400 machines. But haemodialysis remains hard to access for the large numbers of patients who have no dialysis centres near their homes.
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The ministry has asked the states to set up panels led by nephrologists at government hospitals to oversee the introduction of peritoneal dialysis.
“This is a major decision that could improve the quality of life of patients, ” said senior nephrologist Vivekanand Jha, executive director of The George Institute of Public Health, New Delhi, and chair of an expert panel that had recommended the health ministry introduce peritoneal dialysis into the NDP.
Although the technology has been available for nearly two decades, peritoneal dialysis has not become popular in India. Health experts estimate that about 225, 000 people across the country develop end-stage kidney disease each year, typically the outcome of uncontrolled diabetes or high blood pressure.
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The number of patients on dialysis is estimated to range between 75, 000 and 100, 000. Only about 6, 500 of them are estimated to be on peritoneal dialysis.
“Haemodialysis means repeated visits to clinics or hospitals and opportunities for nephrologists to earn money. There’s been a bias away from peritoneal dialysis in the private sector, ” Jha said.
They say that haemodialysis, which costs a paying patient about Rs 2, 600 a session at a public hospital, is comparable in cost or more expensive than peritoneal dialysis, depending on the number of dialysis sessions per week.
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In peritoneal dialysis, the one-time spending on the catheter-related devices comes to about Rs 10, 000, while the dialysate solution currently costs Rs 15, 000 to Rs 20, 000 a
