Remote patient monitoring in Peritoneal Dialysis minimizes the need for hospitalization amidst the pandemic

The looming threat and fear of coronavirus have pushed people back inside their homes. The year 2020 showed us limitations in the healthcare infrastructure, unable to support critical healthcare issues. The lockdown affected transportation, access to health care facilities, and availability of medicines and consumables as well as outpatient and inpatient services. Unfortunately, the second deadlier wave this year has had a worse impact which is seen on the care of patients with non-communicable diseases, including those suffering from kidney-related ailments.

There are about 20 lakh kidney disease patients added in India who require 34 million dialysis sessions every year.  According to a recent Kidney International Report, a survey was conducted to determine the effect of lockdown on the care of patients with kidney disease. Approximately 710 (28.2%) patients missed one or more dialysis sessions, 69 (2.74%) required emergency dialysis sessions, 104 (4.13%) stopped reporting for dialysis, and 9 (0.36%) were confirmed to have died. Outpatient attendance in the surveyed hospitals came down by 92.3%, and inpatient service reduced by 61%. Tele-consultation was started but was accessed by only a small number of patients.

“The pandemic has changed our perception of healthcare delivery. With the excessive load on hospitals to prioritize COVID-19 patients, we must be open to moving towards remote patient management for other diseases, where feasible. As for kidney patients, home-based and cost-effective PD therapy can enable nephrologists to treat kidney patients at home rather than continuing with hemodialysis to aid the kidney failure population in the country. Peritoneal Dialysis is a dialysis technology that not only avoids the substantial costs of infrastructure set up, maintenance and staffing but it reduces the pressure on the overall healthcare system at a time when the world is already fighting a global pandemic. APD (Automated Peritoneal Dialysis) makes it easier. This technology integrates with a two-way remote patient management platform called Share source. This means that patients performing APD at home are connected via the internet to clinicians in their renal unit and the system enables the transfer of therapy and patient biometric data to clinicians, allowing them to monitor the patient in real-time”, said Dr. Vidyashankar P, Chief Nephrologist, Aster CMI Hospital, Bangalore.

The lives of the patients with diabetes and kidney diseases have been in disarray as patients especially on hemodialysis (HD) have to frequently visit hospitals for dialysis. According to the Ministry of Health and Family Welfare (MoHF&W), people having co-morbidities like Chronic Kidney Disease (CKD) and on dialysis, are at an increased risk of contracting the deadly virus. CKD is a major cause of mortality and morbidity in India. So, to avoid hospital-acquired infections in a healthcare setting, the energies shifted to video consultations, remote patient management, and other measures for non-COVID-19 patients.

Patients suffering from diseases like chronic kidney disease, diabetes, etc. are struggling to get timely treatment. These patients are left unnoticed and untreated as hospitals and other health clinics have been converted into a COVID-19 treatment center. In such a scenario, patients who are suffering from CKD and are on hemodialysis find it difficult to travel to hospitals for their sessions as these visits can lead to getting contracted with COVID. Therefore, with advanced medical options, patients can now get treated with home-based Peritoneal Dialysis.

PD allows patients to move freely at home and maintain a flexible lifestyle. One can perform the therapies per convenience without having to worry about visiting a hospital, unlike the conventional Haemodialysis which demands a patient to visit a hospital 3-4 times a week. PD saves patients multiple clinic visits and is generally more cost-effective and scalable as it can be carried out at home and has lower infrastructural requirements.

Despite PD’s potential advantages, its penetration in the country is very poor. According to a report, there were just about 8,500 patients on PD in India in 2019. However, with effective reforms in our healthcare system, such progressive decisions can address challenges pertaining to accessibility and quality healthcare in the country to reach even the vulnerable and the marginalized sections of society.

“PD frees patients from the multiple visits to the clinics every week as applicable in the conventional Haemodialysis (HD) and can be performed at home without any specialized equipment. In fact, it can be easily carried out at home by the patient, often without help. Contrary to an HD session, PD is a painless and needle-less procedure that allows the patient to lead a better quality of life even with the chronic ailment” says Dr. Vidyashankar.