Dialysis was introduced to this Earth in the 1940s and the first-ever dialysis treatment was done by William Kolff a Dutch doctor who is known to be the pioneer of Hemodialysis and is very well known by all Renal Replacement Therapists (RRT’s).
From then as time passed by, many researchers have shown interest in dialysis technology and now we can able to provide the best dialysis treatment known to mankind. All these improvements in dialysis technology are possible only by setting up standards for dialysis delivery and investing in research by various organizations around the globe. Currently, we have many organizations investing in research, providing Quality Standards for dialysis delivery, and sharing knowledge among RRT’s.
Because of improvements in dialysis standards and its delivery, now we can easily concentrate on the vast majority of segments in dialysis like modalities of treatment, adequacy of dialysis, improving the quality of life of dialysis patients, and many more.
In India, Hemodialysis was first introduced in 1961 and Peritoneal Dialysis was introduced in 1991. Even for today dialysis is expensive in India, on an average, a dialysis patient in India spends INR 3000/- on Hemodialysis per week. Healthcare expenditure does not cover dialysis. Lack of insurance/reimbursement facilities funding of dialysis is patient-driven, requiring out-of-pocket expenditure.
To provide equitable, cost-effective and socially acceptable ways to provide dialysis, in 2016 Government of India introduced Pradhan Mantri National Dialysis Program as a part of the National Health Mission (NHM) for the provision of free dialysis services to the below poverty line (BPL) individuals. And this program also helps to set up dialysis services in Public-Private Partnerships in the country. Where the government helps in setting up dialysis facilities in the country, currently insurance facilities are made available to dialysis patients in the form of insurance coverage through active employment, retirement policy, government insurance like Rashtriya Swasthya Bhima Yojana and many regional insurances.
Moreover, as the demand for dialysis is increasing, many dialysis facilities in the country have fallen in the domain of private “for-profit” health care section. And to reduce the cost many dialysis facilities are run by minimum requirements with no proper architecture and inadequate or no training in dialysis delivery.
To put a stop for all these improper not so efficient healthcare delivery, many organizations from all over the world came forward to provide guidelines and set up standards for dialysis delivery.
Various health care organizations like Quality and accreditation institute center for accreditation of health and social care, International health facility guidelines, and Directorial of health and general services of the country provided standards for hospital-based dialysis centers.
Collections of patient data to measure outcomes are done by Medical Review Boards of the country. In India, there was no End-Stage Renal Disease (ESRD) data were monitored, until recently the Indian Society of Nephrology (ISN) started to maintain the ESRD registry which will help many researchers as well as to measure outcomes and effect of ESRD in the country.
The Association for the Advancement of Medical Instrumentation (AAMI)and The International Organization for Standardization (ISO) have standards for dialysis water treatment, dialysis solution preparation, and dialyser reprocessing.
The Food and Drug Administration (FDA) has put up quality guidelines for hemodialysis devices which covers dialysers and blood tubing, monitoring devices, and alarms, dialysis machines, dialyser reprocessing equipment, water treatment, and all other dialysis devices.
Clinical Performance standards such as adequacy of dialysis, vascular access care, anemia management, etc are provided by National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI).
In India majority of these guidelines are remodeled according to Indian dialysis facility requirements and Standard Treatment Guidelines are provided by the Indian Society of Nephrology (ISN) along with the Ministry of Health and Family Welfare, Government of India.
Dialysis delivery in India is improving day by day with advanced techniques and highly trained ambitious preceptors training young motivated RRT’s. Still, we can see few poor dialysis deliveries in both urban and rural areas of the country, but if we spread the knowledge on dialysis delivery standards, implementing continuous quality improvement programs along with strict audit, proper staff and patient education, and following up with guidelines will bring huge improvements in the dialysis delivery in India.
LazyKidney 