The recent past has seen the nephrology space going through rapid transformation and remarkable changes.Especially concerning dialysis, a space that has been dealing with quite a few sore points for a decade. Today, this space has evolved and transformed into a patient-centered one, bringing hope to millions afflicted with Chronic Kidney Disease while addressing the pain points of patients and nephrologists alike. Novel approaches and avant-garde technologies have focussed on making dialysis more equitable and efficient while ensuring enhanced clinical outcomes.
By Sonali Patranabish
Chronic kidney disease (CKD) has become a persistent challenge for India and a growing cause for concern, given its added burden on the economy and healthcare systems. The rate of CKD in India stands at 800 per million population (pmp) while for ESRD it is 150-200 pmp according to an article on Chronic disease in India: Challenges and Solutions published in Nephron Clinical Practice.
Senior nephrologist Dr Gurudev KC associated with Ramaiah Memorial Hospital states that close to 10 per cent of the Indian population suffers from CKD. With the prevalence of lifestyle diseases like diabetes and hypertension on the rise it is bound to be that a parallel and imminent rise of CKD will also be expected. Renal replacement therapy (RRT) becomes the only go-to option in cases of CKD and End Stage Renal Disease (ESRD).
Statistics in a research paper in the Journal of the American Society of Nephrology, claim that at least 90 per cent of patients requiring RRT die, due to the unavailability of affordable care while 60 per cent halt their treatments owing to financial reasons.
Dr RamMohan Sripad Bhat, Director, Institute of Nephrology, Kauvery Hospitals, Electronic City, Bangalore says, “A 2018 estimate put the number of dialysis patients in India to be 1.75 million (17.5 lakh) and also noted that three times more patients with kidney failure died that year without being able to access dialysis. 19.5 million (1.95 lakh) patients availed PM dialysis programme in 2023 and an equal proportion, if not more, have dialysed in the private sector. Hence the burden of severe kidney failure requiring long-term dialysis has more than doubled within five years (2018 to 2023). This is just the start of the explosion.”
The dialysis treatment landscape finds itself in murky waters, pitted amidst a myriad of challenges, the one that stands out the most are in terms of poor clinical outcomes and complications like cancer risk, reduced mobility, anaemia, cardiovascular disease (CVD) and predisposition to infection. To combat these challenges various groundbreaking technologies have emerged that have the potential to improve the quality of life of patients post-dialysis in terms of reduced symptom burden and functioning at their optimal level. Today patient centred innovation in dialysis is working on transforming the dialysis landscape into one which is more convenient and affordable.
Dialysis is considered a lifeline for patients but the current treatment modalities lack efficacy. Despite this, the field of dialysis has gone through very few iterations since its inception. Regulatory challenges, myths around dialysis, and economic issues have clouded this field and stalled further research. Nevertheless, this crucial wing of Kidney research is catching up the pace.
Dr Kranthi Kumar and Dr Varun Mamidi, Nephrologists, AINU, Hyderabad share their opinion on the urgent need for accelerated innovation in this field. “The current modes of renal replacement therapy replace only the filtration function of the failed kidney without addressing its other vital metabolic, endocrinologic, and immunologic roles and portability. It is vital to have newer therapies with a goal of total replacement and not just clearance and with a focus not just on improved survival but also on patient-centred needs such as enhanced portability, the flexibility of therapy, reduced interventions, improved quality of life, and a reduction in the economic impact of dialysis on the family and society as a whole.”
Few of the current advancements are indeed testimony to the transformation the field is going through. Dr P Vikranth Reddy, Head of the Department and Chief Consultant Nephrology, CARE Hospitals, Banjara Hills, Hyderabad stated that hemodiafiltration, portable dialysis machines, wearable dialysis devices, wearable artificial kidneys, sorbent technology, nanotechnology in dialysis membranes and Bioartificial kidneys.
“These innovations hold promise for improving the quality of life for dialysis patients and addressing some of the limitations associated with current dialysis modalities,” opines Dr Reddy.
Hyderabad-based Virinchi Hospitals in collaboration with Renal Research Institute, New York) and Vivo Biotech is coming up with an innovative dialysis treatment which will be available in two to three years at one hundredth the cost. This alternative dialysis treatment named Allo-dialysis has begun its last stage of development.
In yet another joint venture, Hyderabad-based Nephroplus in collaboration with Shri Vamshi Hospitals has launched innovative container dialysis units to circumvent space constraints at hospitals. Co-founder of Nephroplus, Kamal Shah mentioned that these units have a capacity of four patients.
In an attempt to circumvent problems associated with conventional peritoneal dialysis(PD), Mitra Industries has come up with a triple-chambered peritoneal dialysis solution which works at a neutral pH. The Managing Director at Mitra Industries says that such advancements in the field of nephrology are CKD patients whose life-line is PD and the innovative PD solutions are enhancing patient outcomes as well as nephrologists.
Himanshu Baid, Director, Poly Medicure, claims that the dialysis business was a 100 per cent import dependent business with respect to consumables and machines. Baid stated that as a company they have moved towards manufacturing their dialysis equipment with help from the PLI scheme of the GoI.
Mumbai-based healthcare start-up – The Renal Project, founded by Shashank Moddhia has created a revolutionary model by setting up micro-centers for dialysis in tier II and III cities. Moddhia says, “Our micro-centres enable sustained dialysis therapy, minimising travel risks like infection and fatigue. We are committed to reshaping renal healthcare, ensuring accessible dialysis for all in need.”
In recent times India has scaled up amongst other top global nations as one of the key providers of high-quality cost-effective kidney treatments and care. The Innovation map for nephrocare looks upbeat with emerging technologies that are proving to be more sustainable and cost-effective.
