Kerala looks to pursue a “PD-First” policy

Subsidised CAPD at home had been piloted by the Health department in three districts in 2018, with the government now looking to upscale the project

As the Health department gives patients with end-stage renal diseases (ESRD) the option of continuous ambulatory peritoneal dialysis (CAPD) at home free of cost, patients in the State are being offered fresh hope.

Subsidised CAPD at home is a scheme that had been piloted by the Health department in three districts in 2018, with limited success. The Government has now announced the upscaling of this project across 11 districts to offer CAPD totally free of cost to ESRD patients

Peritoneal dialysis (PD) continues to remain an under-utilised strategy for patients who have to be started on dialysis treatment following ESRD. While it offers the advantage of cost-saving, flexibility and independence to patients, there are also inherent disadvantages like infections, failure of technique or insufficient dialysis clearance over time.

However, even when PD is definitely an option worth exploring, the Government will need to address the inherent challenges and the many social and clinical realities involving chronic renal disease patients if PD has to be a sustainable programme, experts caution.

Moreover, lack of expertise and facilities in the State health system to handle dialysis patients and the total absence of a State CKD (chronic kidney diseases) registry to monitor and track the increasing population going into dialysis, dialysis quality and survival data are major lacunae if the State intends to adopt “PD First” (PD as the primary modality of renal replacement therapy, rather than haemodialysis, for a patient starting on maintenance dialysis) as an established health policy

Palakkad, Alappuzha, Ernakulam districts have had some success with patients on PD but the numbers are low.