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Panel pushes for affordable dialysis

New Delhi, Feb. 24: An international medical panel has called on governments to ensure cost-effective and equitable access to dialysis that meets minimum safety and quality standards worldwide, including India where about 2 lakh patients face end-stage kidney failure each year.

The 10-member panel has also prescribed audit mechanisms that encourage transparent reporting of dialysis costs and outcomes amid concerns about variations in services in India where dialysis can cost anything from Rs 650 to over Rs 3,000 per session.

The recommendations come at a time the Union health ministry is rolling out free dialysis services in every district hospital in India to increase access to a treatment that doctors estimate is now available to less than a third of patients who need it.

Doctors estimate that India already has about 1,500 dialysis centres across the country, but the majority are in the private sector charging patients and thus unavailable for many.

"Free dialysis in district hospitals does not mean equal access to every patient," said Vivekanand Jha, executive director of The George Institute for Global Health, New Delhi, and head of the Ethical Dialysis Task Force, the medical panel set up by the International Society of Nephrology.

The panel has published its recommendations in today's issue of The Lancet.

Nephrologists point out that many patients who live far from district hospitals may be unable to travel several hours daily thrice a week - a typical frequency for dialysis. The panel's recommendations for cost-effective and equitable access, Jha said, become relevant to address such concerns.

"The challenges include increasing access to dialysis, helping patients and their families to make the best decisions about management of advanced kidney failure, and to ensure that patients receive affordable high-quality dialysis care based on standards accepted worldwide," Jha said in a media statement.

"We must ensure minimum standards of quality and safety in dialysis units and regulations should be introduced to ensure these standards are maintained," Jha said. "We also need audit systems to assess costs."

The panel has expressed concern that socio-economically disadvantages patients might have access only to dialysis facilities with relatively low-quality services or be turned away by facilities that provide better-quality services and recommended "regulatory safeguards" to prevent undue commercial influences on clinical decision-making.

The panel has also called for strengthening communication between nephrologists and patients so that patients and their families are better informed about the illness and its implications. It has, for example, recommended dialysis units help prepare patients for future decline in their health.

Nephrologists not associated with the panel said India's challenges lie in its large number of patients and the lack of adequate actions to curb the annual addition of patients with kidney failure.


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