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News & Events
AT HOME WITH DAILY DIALYSIS
13th March 2008
Today, on World Kidney Day, we bring you the inspiring story of Madhu Sharma, a 42-year-old homemaker, who has been taking care of her chronic kidney disorder all by herself. Sharma is among an increasing number of patients who are doing dialysis from home. That too, without any side-effects.
Madhu Sharma
Madhu Sharma is as fit and active as any 42-year-old woman would be. She prepares her two sons for school, cooks for the family and does all other household chores. That the Rajouri Garden resident is suffering from chronic kidney failure for the past four years does not show on her face. Sharma is among an increasing number of kidney patients in the national capital region (NCR) who have taken charge of the situation by doing their dialysis on their own from home.
Doctors may have their own take on the good and bad effects of doing dialysis from home. But Daxter, a company that markets, fluid and equipment for the procedure, claims it has over 1,500 patients doing home-based dialysis — it’s called Continuous Ambulatory Peritoneal Dialysis (CAPD).
Sharma, who has to do dialysis thrice a day, says the only extra effort needed is getting up an hour early. This is how it is done: A tube is inserted into the peritoneum and the fluid is poured in. The fluid then drains out the toxics using diffusion and osmosis methods. “1 do everything on my own. Sometimes my husband helps me,” Sharma says. Earlier, she used to go to hospital and wait in a queue for hospital-based dialysis known as haemodialysis. “Besides the daily travel hassles, there was also dependence on the doctor and the machine. Now, I am more on my own,” she says.
DOCTORS’ TAKE
Dr N.K. Singh, a senior consultant in Maulana Azad Medical College (MAMC), says the two methods of dialyses and transplant are complementary to each other. While CAPD can be done from home, it costs more than haemo-dialysis (that is, if the dialysis is being done in a government hospital). However, the cost is 4lmost the same if a patient is getting it done in a private hospital (Rs 20,000).
CAPD is less time-consuming and prevents further damage to the kidney, says Dr A.K. Bhalla, a nephrologist at Sir Ganga Ram Hospital. The only reason why CAPD is not as popular as it should be is because it came after haemodialysis. It’s otherwise the perfect answer to those who can’t undergo organ transplant. “I have scores of patients who have been doing CAPD ‘for over 10 to 15 years. They are all leading a good life,” he says.
However, since the catheter (the tube) is constantly placed inside the body, there are chances of infections, says Dr Singh.
DIET THERAPY
Aging population and increasing incidence of diseases like diabetes and hypertension have resulted in an increase of chronic kidney disease (CKD). Right diet could actually be the treatment for a CKD patient who can’t afford a transplant or dialysis, say doctors. Less nitrogen (proteins) in diet helps check progression of CXI), says Dr K.S. Nayak, a nephrologist of Global Hospital, Hyderabad.
FIRST NO-STEROID TRANSPLANT IN INDIA
Fortis Hospital on Wednesday said it has performed the first kidney transplantation in India without administering, steroids to the patient. A nine-year-old girl from Srinagar underwent the surgery. She is doing absolutely fine, says Dr Sanjiv Gulati, transplant surgeon of Fortis Hospital.
Steroids are commonly administered in kidney transplant surgeries so that there is no organ rejection. However, these medicines have side effects. Many patients who had been administered with steroids are known to suffer from cataracts and bone diseases. Besides, they may have growth impairment.
“Since the girl is quite young and steroids could have hampered her growth, we decided not to use steroids,” says Dr Gulati. As an alternative, injection of antibodies were given to her. As it is a very complex surgery few surgeons want to take the risk without steroids. Besides, injection of antibodies like Simulect is very costly, says Dr Gulati. One vial of Simulect costs around Rs 1.5 lakh.
However, this protein restriction leads to malnutrition and can even threaten survival. Through a technique called Ketoanalogues, amino acids (proteins) could be provided without a corresponding ‘nitrogen load’.
Ketoanalogues are used in CKD in both pre-dialysis and dialysis stages. In the pre-dialysis stage, ketoanalogues slow down the disease and can postpone the onset of dialysis by many years. “Some studies say Ketoanalogues slow down the progression of the disease. However, there is no conclusive evidence,” says Dr. Sanjiv Gulati, transplant surgeon of Fortis Hospital.
